RT Journal Article
SR Electronic
T1 How do doctors address heart failure patients’ disclosures of medication adherence problems during hospital and primary care consultations? An exploratory interaction-based observational cohort study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e098826
DO 10.1136/bmjopen-2025-098826
VO 15
IS 4
A1 Frigaard, Christine
A1 Menichetti, Julia
A1 Schirmer, Henrik
A1 Wisløff, Torbjørn
A1 Bjørnstad, Herman
A1 Breines Simonsen, Tone Helene
A1 Gulbrandsen, Pål
A1 Gerwing, Jennifer
YR 2025
UL http://bmjopen.bmj.com/content/15/4/e098826.abstract
AB Objectives To investigate how doctors and self-managing older patients with heart failure (HF) discuss the patients’ potential or ongoing medication adherence problems, and how such discussions evolve as patients transition from hospital to home, with particular focus on: (1) doctors’ communicative actions aimed at addressing patient disclosures of adherence problems and (2) patients’ feedback indicating whether their doctor’s supportive actions were acceptable to them.Design Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient–doctor consultations, audio recorded for each patient at: (1) first ward visit in hospital, (2) discharge visit from hospital and (3) follow-up visit with general practitioner (GP).Setting Hospital and primary care, Norway (2022–2023).Participants 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs).Results Analysis of 74 consultations revealed that 25 HF patients disclosed 23 practical adherence problems indicating risks of unintentional non-adherence (eg, limited resources to manage medications) and 39 perceptual problems indicating risks of intentional non-adherence (eg, worries, negative experience or stance). Doctors addressed 79% of patients’ disclosures by: (1) exploring the scope of the problem or (2) providing supportive actions to improve patients’ ability or motivation to adhere. We calculated nearly five times higher odds for doctors to address patients’ practical problems to their perceptual problems (OR 4.79, 95% CI 1.25 to 25.83). Unresolved problems included: (1) doctors addressed patients’ disclosures, but patients signalled the supportive actions were unsuitable (37%) and (2) doctors left disclosures unaddressed (21%).Conclusions In this explorative study, the doctors were more likely to address the patients’ adherence problems associated with unintentional non-adherence risks than those associated with intentional non-adherence risks. Even when doctors attempted to address HF patients’ medication adherence problems, half of the problems remained unresolved, usually because patients indicated that the doctor’s suggestion to improve their situation was against their preference.No data are available. This study uses audio recorded authentic medical consultations. We do not have permission to share these with other researchers.