Nurse prescribers’ exploration of diabetes patients’ beliefs about their medicines

Abstract

Evidence suggests that non-adherence to medicines is an ongoing problem for people with diabetes and can adversely affect mortality, morbidity and health outcomes. Recent evidence and national guidance has reported patients’ medicine beliefs as an important antecedent of non-adherence, however, a review of the entire medicine beliefs literature has yet to be conducted and no research has explored the experience of nurses and patients involved in an exploration of patients’ medicine beliefs in routine practice settings. Conclusions from chapters 2 and 3 indicated nurse prescribers’ are not, but should be, exploring patients’ medicines beliefs in routine practice to optimise adherence and health outcomes.

A mixed methods concurrent triangulation design was used to (a) quantitatively observe and measure nurse prescribers’ exploration in routine consultations, (b) qualitatively investigate the barriers and facilitators to nurse prescribers’ exploration, and (c) qualitatively investigate diabetes patients’ perceptions of consultation discussion having participated in consultations whereby nurse prescribers’ explored diabetes patients’ medicine beliefs. Findings were integrated in order to develop additional inferences.

Fourteen nurse prescribers’ audio-recorded 154 routine consultations with diabetes patients over several time-points and 620 instances of medicine discussion were observed. Medicine beliefs sub-concepts, concerns and necessity, were conceptually mapped to MEDICODE themes and the analysis indicated nurse prescribers’ were moderately exploring patients’ medicine beliefs.

A thematic analysis of thirty interviews with nurse prescribers identified a range of nurse, patient, and contextual tensions that influenced nurses’ exploration attempts. These included patients’ willingness to engage, different exploration approaches by nurses, patient characteristics, and a wide range of contextual problems such as inadequate time, disruptive settings, and competing agendas. Thematic findings from 28 patient interviews also identified a range of perceptions about the experience of having their medicine beliefs explored. Nurse-patient rapport was considered vital for exploration by both nurses and patients.

All three study components were integrated in the discussion and developed into a conceptual model of the perceptions and influences on patients’ medicine beliefs exploration by nurse prescribers. This thesis was the first attempt to understand the practical reality of this consultation activity. Exploration of patients’ medicine beliefs in routine practice settings was difficult and subject to a number of tensions, facilitators and barriers within the context of diabetes care. Importantly, future research can utilise these findings to develop strategies to support interventions

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Identifiers

ORCID for Andrew Sibley: orcid.org/0000-0002-2503-5432

ORCID for Susan Latter: orcid.org/0000-0003-0973-0512

ORCID for Richard Wagland: orcid.org/0000-0003-1825-7587

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