Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, Catalonia, Spain; School of Pharmacy, University of Barcelona, Barcelona, Catalonia, Spain; Primary Care Prevention and Health Promotion Research Network (REDIAPP), Barcelona, Catalonia, Spain.
Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
Res Social Adm Pharm. 2020 May;16(5):663-672. doi: 10.1016/j.sapharm.2019.08.002. Epub 2019 Aug 6.
Non-initiation occurs when the doctor prescribes a new pharmacological treatment to a patient who does not fill the prescription. Non-initiation prevalence estimates range between 6% and 28% in Primary Care (PC) and it is associated with poorer clinical outcomes, more sick-leave days and higher costs. To date, the reasons for non-initiation have not been explored using a qualitative framework.
The aim of the present study was to identify reasons for medication non-initiation among PC patients with distinct treatment profiles (acute, chronic symptomatic and asymptomatic, and mental disorders).
An exploratory, explanatory qualitative study based on Grounded Theory. We conducted individual semi-structured interviews with 30 PC patients. A constant comparative method of analysis was performed.
The results were similar for all therapeutic groups. The decision to initiate treatment is multifactorial. Users make a risk-benefit assessment which is influenced by their beliefs about the pathology and the medication, their emotional reaction, health literacy and cultural factors. The patients' context and relationship with the health system influence decision-making.
The decision to initiate a treatment is strongly influenced by factors that health professionals can discuss with patients. Health professionals should explore patients' beliefs about benefits and risks to help them make informed decisions and promote shared decision-making. General practitioners should ensure that patients understand the benefits and risks of disease and treatment, while explaining alternative treatments, encouraging patients to ask questions and supporting their treatment decisions.
当医生为未开具处方的患者开新的药物治疗方案时，就会出现未起始治疗的情况。在初级保健（PC）中，未起始治疗的发生率估计在 6%至 28%之间，与较差的临床结局、更多的病假天数和更高的成本有关。迄今为止，尚未使用定性框架探讨未起始治疗的原因。
本研究旨在确定具有不同治疗特征（急性、慢性有症状和无症状以及精神障碍）的 PC 患者未起始药物治疗的原因。
这是一项基于扎根理论的探索性、解释性定性研究。我们对 30 名 PC 患者进行了个体半结构化访谈。采用恒定比较法进行分析。
所有治疗组的结果均相似。开始治疗的决定是多因素的。使用者会对风险和收益进行评估，这受到他们对疾病和药物的看法、他们的情绪反应、健康素养和文化因素的影响。患者的背景和与卫生系统的关系会影响决策。
治疗决策受到健康专业人员可以与患者讨论的因素的强烈影响。卫生专业人员应探讨患者对获益和风险的看法，以帮助他们做出明智的决策并促进共同决策。全科医生应确保患者了解疾病和治疗的获益和风险，同时解释替代治疗方法，鼓励患者提问并支持他们的治疗决策。
