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Title: Prescribing for prevention in primary care : exploring patients' views on risk management medicines
Author: Dohnhammar, U. E.
ISNI:       0000 0004 6059 6803
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2016
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Prevention of disease is a key strategy in the NHS, contributing to cost-effective health care and lower morbidity and mortality through early identification and management of risk factors in large populations. However, effects of increased prescribing, in the form of a growing burden of treatment for patients and challenges associated with polypharmacy, have prompted criticism from medical practitioners as well as scholars from the biomedical and social scientific fields. Whilst a growing evidence base guides prescribing, factors in the social world also influence how medicines are used. Patients’ views on medicines are recognised as important for a good outcome of treatment, but they are not very well known with regards to risk management prescribing and polypharmacy. The research presented in this thesis draws on critical examinations of societal influences on large-scale prescribing, and focuses on cardiovascular (CVD) risk management in primary care. This approach allowed me to explore the use of medicines in a setting where prescribing is common but also involves challenges in terms of the balancing of beneficial and harmful effects for populations and individuals. General influences on patients’ expectations of prescribed medicines were addressed in a review and synthesis of medical and social scientific literature describing beliefs, views and experiences. An update of the national clinical guidance on CVD risk assessment and modification of blood lipids offered an opportunity to review how CVD risk and the benefit and harm from statins were represented in a lay context; UK newspapers. In the empirical part of the research, I explored patients’ understanding of their own use of medicines in CVD risk management. My findings produced a thematic structure describing how patients conceptualise a diagnosed CVD risk and make sense of the recommended risk management treatments. Central influences on patients’ views are a simplified representation of CVD risk as a distinct condition with particular consequences for the individual, anticipation of defined effects from medicines, and a personalised understanding of health information which leads to individual responsibility for engaging with risk management. To propose implications of my findings, I discuss them in relation to three current policy reports on disease prevention and prescribing. My study adds knowledge about a central part of modern primary care, based on suggestions of how the currently dominating approach in CVD prevention might shape people’s perspective of medicines.
Supervisor: Walley, T. ; Reeve, J. ; Dickson, R. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral