University affiliation
University of Gothenburg
Main supervisor
Andreas Fors, Senior lecturer
PhD project participating in the National Research School in General Medicine.
Non-adherence to prescribed medicines is common among patients with chronic diseases treated in primary healthcare. Research suggests that person-centred care (PCC) with focus on co-creation of care through partnership can help these patients to make informed choices regarding medicine taking. PCC involves shared decision making and is expected to result in concordance in the prescribing of medicines, but if this has an actual impact on medicine use has been sparsely explored in previous research.
The aim of this PhD thesis is to contribute with a broader understanding of determinants that influence medicine taking for chronically ill persons treated in primary healthcare, and of the impact of PCC on medicine taking.
Study I and IV are qualitative studies. Study I, an interview study published in British Journal of General Practice Open in 2022, explored how frail older persons receiving Home Care in primary healthcare perceive everyday life with polypharmacy, i.e. use of 5 or more medicines daily. Data was analysed with inductive thematic analysis. Study IV will be a focus group study, aiming to explore how primary healthcare professionals view their role in supporting rational medicine taking among patients with chronic disease. Data will be analysed with a method for focus groups developed by Krueger and Casey
Study II and III, both secondary register-based analyses, will use data from the randomized controlled trial PROTECT (Person-centred care at distance), evaluating the effects of PCC through a combined digital platform and telephone support for patients with chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) in primary healthcare. This data will be merged with register data from the Swedish Prescribed Drug register, from which adherence to medicines can be calculated. Study II aims to evaluate if PCC can result in increased use of prescribed medicines for COPD and/or CHF. Study III aims to find factors, associated with the patient or the care process, that correlates with variation in dispensing patterns of medicines used for treating COPD and/or CHF. Variations in dispensing patterns will be identified using Group-based trajectory modelling, a statistical method for analysing evolution of an outcome over time. The hope is to find factors that can predispose to irrational medicine use, and to follow these patients’ response to PCC.
This PhD project in PCC for persons with chronic disease in primary healthcare will contribute to an improved understanding of determinants of medicine related decision making, from patients’ as well as caregivers’ points of view. Given an aging population and widespread use of multiple medicines, this kind of knowledge is crucial to enhance safety regarding use of medicines in everyday clinical practice and improve conditions for PCC.
University of Gothenburg
Andreas Fors, Senior lecturer