How and Why Do Multimorbid Patients Decide to Follow Their Multiple Medication Prescriptions? Looking Beyond the Risk-Benefit Scale.

Abstract

Current public health guidelines emphasize the necessity to optimize medication prescriptions for multimorbid patients with multiple medications to ensure patient adherence while minimizing harm and waste. Nevertheless, there is limited understanding of how these patients choose to follow their medication regimen. This study aimed to describe the variations in the way patients account for their adherence (and non-adherence) to multiple medications and to draw links between these variations and patients' socioeconomic status. Twenty semi-structured interviews were conducted with patients aged 47-82 years with cardiovascular disease and multiple medically treated chronic conditions. They were transcribed and analyzed using reflexive thematic analysis. We first describe shared concerns about multiple medication taking and situations of medical uncertainty which arose when patients encounter conflicting medical instructions. We then highlight two overarching approaches through which patients conceptualized following their medical prescriptions. Some patients predominantly deferred the choice of medication to their physicians, while others steered the decision-making process and closely monitored what they were prescribed. These styles reflected different ways of engaging with doctors, dealing with side effects, and evaluating prescriptions and were linked to patients' socioeconomic status. We discuss our results by borrowing from Hirschman's theory of voice, exit, and loyalty. Findings argue in favor of better coordinated care to reduce prescription ambiguities and highlight the importance of patients with multimorbidity being given sufficient time and space to voice their concerns.