"I just take what I am given": adherence and resident involvement in decision making on medicines in nursing homes for older people: a qualitative survey.
BACKGROUND
Adherence to medication is generally considered to be poor in many patient groups, but little is known about adherence to medication in the nursing home setting. It is also unclear if residents in nursing homes are involved in decision making about medication.


OBJECTIVE
This study sought to explore adherence to medication and resident involvement in prescribing and decision making in regard to medicines in the nursing home setting.


METHODS
This was a qualitative study. Participants took part in either semi-structured interviews (general practitioners [GPs] and residents) or focus groups (nurses) to discuss issues around prescribing and adherence to medication in nursing homes for older people in Northern Ireland. All interviews and focus groups were digitally recorded, fully transcribed and analysed using the principles of constant comparison.


RESULTS
Eight GPs and 17 residents participated in semi-structured interviews and nine nurses participated in two focus groups (n = 4; n = 5). The main theme that emerged was control, which was manifested in many ways. Both groups of healthcare professionals needed to maintain control of prescribing or administration of medication in order to ensure safety, quality and continuity of care. All residents accepted control without question, reported that they were adherent to medication and had little involvement in prescribing decisions or administration of their own medicines. Although the healthcare professionals thought that more involvement in decisions around medication would contribute to resident autonomy and empowerment, it was also recognized that this could adversely affect control within the nursing home.


CONCLUSIONS
Although adherence with medication was generally perceived not to be a problem in the nursing homes setting in this study, other findings raise major challenges for resident involvement in an important aspect of their own care. Although there may be some residents, because of cognitive decline, who are unable to become involved in aspects of decisions about prescribing and self-administration, healthcare professionals providing care to these patients should strive to involve them as far as possible in their own care.
Hughes
Carmel M
CM
School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland. c.hughes@qub.ac.uk
Goldie
Roz
R
D000368:Aged; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008509:Medication Systems / Q000458:organization & administration*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D036301:Qualitative Research