Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate professor Frank Moriarty, RCSI - Royal College of Surgeons in Ireland,
- Second opponent: Professor Aslak Steinsbekk, NTNU - Norwegian University of Science and Technology,
- Third member and chair of the evaluation committee: Professor II Turid Birgitte Boye, University of Oslo
Chair of the Defence
Associate Professor Ingrid Nermoen, University of Oslo
Principal Supervisor
Senior researcher, Jennifer Gerwing, HØKH, Akershus University Hospital
Summary
Many patients with heart failure, a chronic condition prevalent among older people, struggle to use their medications as prescribed, leading to poor symptom control, frequent hospitalisations, and higher mortality. Good communication can enhance adherence, yet limited research exists on how doctors and patients discuss medication use in practice.
This thesis aimed to extend our understanding of why older patients with heart failure might struggle to use their medications as prescribed. We studied audio recordings and written documents from key medical consultations for 25 patients transitioning from the hospital to their homes, focusing on the quality of the verbal and written communication around patients’ ability and motivation to use their medications as prescribed.
Using an inductive approach, we developed systematic analytical methods to investigate: (1) what do patients disclose about their use of medications in clinical interactions, (2) how do doctors address medication adherence problems, (3) how do patients adhere to the evolving treatment plan.
The studies contribute several insights of why patients might struggle to adhere and how doctors can support patient medication adherence: (1) Patients provided most adherence disclosures in response to doctors’ questions. (2) Patients disclosed information about fewer medications than they were prescribed. (3) 55% of patients’ disclosures indicated adherence risks or problems. (4) Patient disclosures were most frequent during GP visits. (6) Doctors addressed nearly 80% of patients’ adherence problems. (7) Nearly 50% of patients’ adherence problems remained unresolved. (8) Most patients received polypharmacy regimens. (9) Optimising pharmacotherapy led to multiple incremental changes. (10) 70% of hospital discharge letters were unclear or missed important information. The thesis discusses the implications of these insights for current practice and proposes new ideas to improve patients’ adherence to medications.
Additional information
Contact the research support staff.