Adherence to antiparkinsonian medication: An in-depth qualitative study.

Int J Nurs Stud. 2012 Feb 17. [Epub ahead of print]

Drey N, McKeown E, Kelly D, Gould D.

Abstract

BACKGROUND:

Adherence to prescribed medication is low. It is a major problem as following practitioners' recommendations is strongly associated with good patient outcomes. Little research has been undertaken with people in the early stages of Parkinson's disease although achieving symptom control depends on regularly timing doses.

RESEARCH QUESTIONS:

How do people with Parkinson's disease adhere to prescribed medication, and what are the antecedents of non-adherence to antiparkinsonian medication?

DESIGN:

Exploratory qualitative study using semi-structured interviews.

SETTING:

Specialist Parkinson's disease clinic in one National Health Service hospital in England.

PARTICIPANTS:

Fifteen consecutive patients not yet in the advanced stages of Parkinson's disease living at home and responsible for managing their own medication or managing medication with the help of their carer.

METHODS:

Semi-structured interviews with open questions.

FINDINGS:

Each respondent demonstrated at least one type and in most cases several different types of non-adherent behaviour. Inadvertent minor non-adherence occurred because patients forgot to take tablets or muddled doses. Minor deliberate deviations occurred when patients took occasional extra tablets or brought forward doses to achieve better symptom control, often to cater for situations that were anticipated as especially demanding. Deliberate major non-adherence was very common and always related to over-use of medication. The experiences of parkinsonism were particular to the individual. The specific circumstances that prompted an episode of non-adherence varied between patients. Nevertheless there was evidence of negotiation between respondents and the Parkinson's disease nurse specialist; medication regimes were altered in conjunction with the patient during formal consultations and by telephone.

CONCLUSION:

Non-adherence to prescribed medication for people with chronic conditions is complex and for people with Parkinson's disease it was possible to identify different types of non-adherence. The possible existence of a typology of non-adherence for people with other chronic conditions merits investigation. Further research is needed to establish whether the findings of this small scale qualitative study can be replicated with a larger, more representative sample and establish how people with Parkinson's disease might be encouraged to adhere to medication regimes to improve symptom control.