title: Individualisation of drug treatments for patients with long-term conditions: a review of concepts.
abstract: OBJECTIVE
  Patients and policy makers advocate that drug treatments should be individualised. However, the term is used in a variety of ways. We set out to identify the range of related terminology and concepts in the general field of individualisation, map out the relationships between these concepts and explore how patients' perspectives are considered.
  
  
  METHODS
  We consulted members of an established patient and public involvement group about their experience of medicine taking for long-term conditions and their ideas about individualisation. We then conducted a scoping review of the literature to explore how terms surrounding individualisation of drug treatment are used and defined in the literature, and to explore the extent to which patients' perspectives are represented, with a view to informing future recommendations as to how individualisation can be operationalised.
  
  
  METHODS
  We identified relevant literature using a range of search strategies. Two researchers independently extracted definitions of terms using a template. Inductive and deductive methods were used to explore the data.
  
  
  RESULTS
  Definitions were categorised according to the following themes: medical management; pharmacogenetics, the patient's perspective; interactions between the healthcare provider and patient and management of long-term conditions.
  
  
  CONCLUSIONS
  Within the literature reviewed, the involvement of patients in the ongoing management of drug treatment was largely absent. We propose the use of a new term 'mutually agreed tailoring' (MAT). This describes the ongoing pharmacological management of conditions that incorporates patients' specific needs, experiences and existing strategies for using their medications, and the professionals' clinical judgement. This usually includes patients monitoring their symptoms and, with the support of the professional, making appropriate product, dose or timing adjustments as necessary. Our previous work suggests that many patients and doctors are successfully practising MAT, so we suggest that a formal description may facilitate wider utilisation of strategies that will improve patient outcomes.
authors.affiliation: University of Exeter Medical School, Institute of Health Research, Exeter, UK.
authors.forename: S
authors.initials: S
authors.lastname: Denford
authors.forename: J
authors.initials: J
authors.lastname: Frost
authors.forename: P
authors.initials: P
authors.lastname: Dieppe
authors.forename: Chris
authors.initials: C
authors.lastname: Cooper
authors.forename: N
authors.initials: N
authors.lastname: Britten
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy*; D019468:Disease Management; D006801:Humans; D010358:Patient Participation; D010597:Pharmacogenetics; D010817:Physician-Patient Relations; D012648:Self Care
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT