Medication use is not a matter of trust

The most important determinants for general practitioners’ (GPs) discussion of medication use with their patients are the time pressure experienced and their familiarity with their patients. These findings were published by NIVEL researchers in the International Journal of Person Centered Medicine.

Worldwide, medication non-adherence is a huge problem. In the western world, between 25-50% of chronically ill patients do not take their medication as prescribed. Previous video-observation studies show that GPs – who, in the Netherlands, prescribe 80% of all medication – only seldom discuss medication taking behaviour. NIVEL examined GPs’ reasons for this. The most important reasons GPs report are the time pressure GPs experience within the consultation and the extent in which GPs feel they know their patient. Within a more longstanding relationship, GPs not readily inquire about actual medication use as they are convinced they can trust their patients to tell them if there would be a problem. Other determinants mentioned are the collaboration with the pharmacist and the practice nurse; they each expect the other to discuss medication use and related issues with the patient.

Reason for encounter
As a result of the restricted amount of time available, GPs need to decide how to manage their precious time. Many GPs appear to consider it more important to spend enough time exploring the patient’s reason for encounter. And when they meet a patient whom they expect to be adherent, they refrain from talking elaborately about the actual medication use. This can, however, be a pitfall. NIVEL research co-ordinator Sandra van Dulmen: “Given the high number of non-adherent patients, these gut feelings can be incorrect. GPs should become more conscious about these assumptions and check these with their patients. In addition, GPs should be more alert on (non-)verbal cues which may mask non-adherence, such as a patient who indicates ‘to dislike whatever type of medication’. By exploring such ideas and unjustified concerns, medication adherence may improve.”

Videorecordings of daily visits
The present study made use of 400 GP visits from 20 GPs recorded on video. Using a selection of the visits in which the GP prescribed any medication, researchers discussed with the GPs several fragments, which could often be labelled as ‘missed opportunities’, in which proper medication use or adherence were (not) discussed with the patient.