title: A qualitative exploration of multiple medicines beliefs in co-morbid diabetes and cardiovascular disease.
abstract: OBJECTIVE
  Multiple medicines are typically prescribed for patients with Type 2 diabetes (T2D) and cardiovascular disease (CVD). Non-adherence to medicines can arise for those who self-manage the complex regimens typical of T2D and CVD. Perceptions about treatment and illness are probable drivers of adherence and self-management behaviours. However, few studies have explored perceptions about multiple medicines and none has examined the complexities of managing medicines used in T2D and CVD. We explored perceptions towards multiple medicines expressed by people managing co-morbid T2D and CVD.
  
  
  METHODS
  Nineteen adults managing multiple medicines for T2D and CVD participated in semi-structured interviews. The interviews were analysed using a modified grounded theory framework.
  
  
  RESULTS
  Participants were sceptical about the prescription of additional medicines, particularly CVD medicines. Often medicines for T2D management were thought to be more important than medicines prescribed for CVD management. Lifestyle change was thought to be a way of reducing CVD risk and this was related to the lower status given to CVD medication. Lipid-lowering medicines were often thought to be the least important CVD medication prescribed, with some participants considering cessation of medicines to test their necessity.
  
  
  CONCLUSIONS
  Despite evidence on the severity of macrovascular complications in T2D being available, participants in this study undervalued their CVD medications. Survey research is needed to assess how widely held these beliefs are and whether these beliefs influence non-adherence. Future research should explore how healthcare professionals can best address such beliefs.
authors.affiliation: Drug Usage and Pharmacy Practice Group, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK. rebecca.stack@postgrad.manchester.ac.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Stack
authors.forename: R A
authors.initials: RA
authors.lastname: Elliott
authors.forename: P R
authors.initials: PR
authors.lastname: Noyce
authors.forename: C
authors.initials: C
authors.lastname: Bundy
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance