title: Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
abstract: BACKGROUND
  Patients with multiple chronic conditions often have multiple prescribers, which has been associated with greater health care utilization and medication nonadherence in claims-based analyses. This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.
  
  
  METHODS
  This qualitative study involved three focus groups comprising 23 outpatients from a single Veterans Affairs (VA) Medical Center with at least one chronic cardiometabolic condition (hypertension, diabetes, dyslipidemia, or congestive heart failure). Participants were asked about their experiences, including perceived of advantages and disadvantages, of having multiple prescribers of cardiometabolic medications. Conventional content analysis was used to analyze the data.
  
  
  RESULTS
  Multiple prescribers arose through referrals and patients actively seeking non-VA prescribers (primary care and/or specialist) to maximize timeliness and access to medications, provide access to medications not on the VA formulary, and minimize out-of-pocket costs. Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.
  
  
  CONCLUSIONS
  Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.
authors.affiliation: Department of Veterans Affairs, Center for Health Services Research in Primary Care, Durham VAMC, 508 Fulton St. (152), Durham, NC, 27705, USA. corrine.voils@mc.duke.edu.|Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA. corrine.voils@mc.duke.edu.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA. betsy_sleath@unc.edu.
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
authors.affiliation: Department of Veterans Affairs, Center for Health Services Research in Primary Care, Durham VAMC, 508 Fulton St. (152), Durham, NC, 27705, USA. matthew.maciejewski@va.gov.|Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA. matthew.maciejewski@va.gov.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease / Q000188:drug therapy*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D019338:Polypharmacy; D036301:Qualitative Research; D014728:Veterans / Q000523:psychology*