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Qaderi J, Lindblom J. Media portrayals of psychotropic agents in AD/HD treatment: A social constructionist approach. Health (London) 2024; 28:431-449. [PMID: 37077030 DOI: 10.1177/13634593231167060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
In recent decades there has been a significant increase in diagnosing children and adults with Attention-Deficit/Hyperactivity Disorder (AD/HD), and in the use of pharmacological treatment with Ritalin, Concerta and Strattera for AD/HD. This development has given rise to scientific criticism, claiming that the pharmaceuticals prescribed by doctors are, to a large extent, ineffective or harmful. This study discusses media's portrayal of treatment of AD/HD. The aim of the article is to develop a social constructionist perspective, highlighting how scientific critique of pharmaceuticals for AD/HD is handled in the mass media. The authors introduce the concept of "psychopharmacological extensibility," which demonstrates the importance of collective definitional processes in society. Psychopharmacological extensibility reflects the fact that the perception of AD/HD agents as beneficial medicines or harmful drugs is open to interpretation and dependent on social factors related to context, power, rhetoric, and marketization. The empirical data are based on 211 articles from eight of the largest newspapers in Sweden, published between 2002 and 2021. The result shows that Swedish mass media, in numerous ways, neglects or undermines the scientific criticism made, thereby facilitating an increased use of the diagnosis and of psychotropic agents in society.
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Dougherty R, Smolenski J, Smith JN. The Lived Realities of Chemical Restraint: Prioritizing Patient Experience. AJOB Neurosci 2024; 15:29-31. [PMID: 38207192 DOI: 10.1080/21507740.2023.2292506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Ryan Dougherty
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Joanna Smolenski
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Jared N Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
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Jaffe K, Richardson L. "I thought it was for guys that did needles": Medication perceptions and lay expertise among medical research participants. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209134. [PMID: 37572960 DOI: 10.1016/j.josat.2023.209134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Although randomized controlled trials (RCTs) examine "objective" indicators of safety and efficacy of investigational drugs, participants may not perceive study medications as neutral entities. Some medications are imbued with social and cultural meaning, such as stigmatized medications for opioid use disorders. Such perceptions surrounding substance use treatments can extend to the research context and shape RCT participants' experiences with and adherence to study medications. METHODS Considering these complexities in substance use research, we conducted a nested qualitative study within a multi-site, pragmatic RCT in Canada testing two treatments (methadone versus buprenorphine/naloxone) for opioid use disorder. Between 2017 and 2020, we conducted 115 interviews with 75 RCT participants across five trial sites in British Columbia, Alberta, Ontario, and Quebec. RESULTS Using an abductive coding approach, we characterized participants by their previous experience with medication for opioid use disorder and by their exposure to drug culture and drug scenes. Across these experience types, we identified systematic differences around participants' perceptions of the study medications, sources of information and expertise, and medication stigma. CONCLUSION Our findings illustrate the critical importance of social context in shaping medication beliefs and study experiences among people who use drugs, with implications for the conduct of future RCTs in substance use.
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Affiliation(s)
- Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA; British Columbia Centre on Substance Use, Vancouver, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada.
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Kilian VL, de Velde Sarah V. An examination of the medicalization and pharmaceuticalization processes of anxiety and depressive disorders in Belgium between 2004 and 2013: how may both disorders be intertwined? Arch Public Health 2022; 80:191. [PMID: 35971128 PMCID: PMC9377052 DOI: 10.1186/s13690-022-00943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
While medicalization and pharmaceuticalization trends of feelings of anxiety and depression have been described in great detail, an empirical examination of these trends is to date lacking. The current study fills this gap in the literature by mapping the use of psychotropic medicines for feelings of anxiety and depression between 2004 and 2013 in Belgium, as well as by examining whether a social gradient might act as a mediator.
Methods
We analyzed data from three repeated cross-sectional waves (2004, 2008, and 2013) of the Belgian National Health Interview Survey (HIS). Multinomial logistic regression was applied to estimate odds in psychotropic drugs use over the observed period.
Results
Using an ideal-typical distinction between traditional anxiety drugs (psycholeptics) and depression drugs (psychoanaleptics), we found that treatment methods for feelings of anxiety and depression were converging. Persons having feelings of anxiety consumed less psycholeptic drugs, in favor of psychoanaleptic drugs throughout the observed period. Moreover, these results were partially mediated by educational level. Persons with higher education were less likely to consume psychotropic drugs than those with lower education, suggesting a trend of demedicalization for feelings of anxiety and depression.
Limitations
Our study observes a limited period, makes use of an ideal typical distinction between psycholeptic and psychoanaleptic drugs, and measurements may be biased by response-bias due to psychotropic drugs use.
Conclusion
Our study shows that psycholeptics increasingly give way to psychoanaleptics in the treatment of both anxiety and depression, despite several scientists calling their effectiveness for both disorders into question.
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Colbert R, Hughes S. Evenings with Molly: Adult Couples' Use of MDMA for Relationship Enhancement. Cult Med Psychiatry 2022; 47:252-270. [PMID: 35031922 DOI: 10.1007/s11013-021-09764-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Within the modern resurgence of psychedelics as medicinal agents for a range of conditions, the story of MDMA (Ecstasy, Molly) has been re-narrated from a dangerous street drug to a breakthrough mental health therapy. Even still, the story of MDMA remains incomplete within a binary discourse of deviant recreational use versus psychotherapeutic-medical use. The present research aimed to uncover an emerging model of MDMA use grounded in the experiences of adult couples using MDMA privately and in the context of their committed relationships. Eight adult couples who self-reported active MDMA use were recruited for confidential in-depth interviews exploring questions related to drug, set, and setting as a general framework for understanding their private experiences with MDMA. A general inductive coding process was used to arrive at four overarching themes: Conscious Use, A Tool for Exploring, Planned Recovery, and Difficult Experiences. Couples reported making purposeful decisions about MDMA use, collaborating together on becoming physically and emotionally "set" for their drug experience. Couples described positive effects on communication, intimate bonding, and providing a relationship "tune up," among other durable changes to the relationship. An emerging cognitive-relational model of "evenings with Molly" contrasts with existing models of use by suggesting the possibility of informed, non-problematic adult use of the drug for cognitive and relational enhancement. With a small, homogenous sample reporting generally positive experiences with MDMA self-administration, findings from this study cannot be generalized. It remains unknown what proportion of the total MDMA user population might align with the non-problematic adult use of MDMA explored in this study. Additional focused investigations might examine the prevalence and varieties of non-clinical use among adults in order to arrive at rational, science-based regulatory frameworks.
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Affiliation(s)
- Robert Colbert
- An Enduring Love, Co., 204 Walnut Street, Suite A, Fort Collins, CO, 80524, USA
| | - Shannon Hughes
- School of Social Work, Colorado State University, 1584 Campus Delivery, Fort Collins, CO, 80523, USA.
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Kalam MA, Shano S, Afrose S, Uddin MN, Rahman N, Jalal FA, Akter S, Islam A, Anam MM, Hassan MM. Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users' Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh. Patient Prefer Adherence 2022; 16:217-233. [PMID: 35115769 PMCID: PMC8806049 DOI: 10.2147/ppa.s345646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/12/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is thought to have led to increased "inappropriate" or "unjustified" seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. PURPOSE This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. METHODS We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. RESULTS The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an "unknown" illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. CONCLUSION Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users' perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka, 1212, Bangladesh
- Correspondence: Md Abul Kalam, Helen Keller International, Bangladesh Country Office, Dhaka, 1215, Bangladesh, Tel +8801912408148, Email
| | - Shahanaj Shano
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
- EcoHealth Alliance, New York, NY, USA
| | | | - Md Nasir Uddin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh
| | - Nafis Rahman
- Department of Public Health, American International University of Bangladesh, Dhaka, 1212, Bangladesh
| | - Faruk Ahmed Jalal
- Handicap International - Humanity & Inclusion, Dhaka, 1212, Bangladesh
| | - Samira Akter
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
| | - Ariful Islam
- EcoHealth Alliance, New York, NY, USA
- Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Campus, Warrnambool, VIC, 3216, Australia
| | - Md Mujibul Anam
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh
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Abstract
OBJECTIVES We explore how older patients affected by polypharmacy manage the 'hidden work' of organising their medicines, how they make sense of this work and integrate it into their lives. DESIGN AND SETTING Ethnographic study observing patients over 18-24 months in patients' homes, general practice and community pharmacy, in England, UK. PARTICIPANTS AND METHODS Ethnographic case study including longitudinal follow-up of 24 patients aged 65 or older and prescribed ten or more items of medication. Our dataset includes: 562 hours of ethnographic observation across patients homes, community pharmacies and general practices; 47 audio-recorded interviews with patients about their lives and medicines practices; cultural probes (photographs, body maps, diaries and imagined 'wishful thinking' conversations); fieldnotes from regular home visits; telephone calls, and observation/video-recording of healthcare encounters. We apply a 'practice theory' lens to our analysis, illuminating what is being accomplished, why and by whom. RESULTS All patients had developed strategies and routines for organising medicines into their lives, negotiating medicine taking to enable acceptable adherence and make their medicines manageable. Strategies adopted by patients often involved the use of 'do-it-yourself' dosette boxes. This required careful 'organising' work similar to that done by pharmacy staff preparing multicompartment compliance aids (MCCAs). Patients incorporated a range of approaches to manage supplies and flex their regimens to align with personal values and priorities. Practices of organising medicines are effortful, creative and often highly collaborative. Patients strive for adherence, but their organisational efforts privilege 'living with medicines' over taking medicines strictly 'as prescribed'. CONCLUSIONS Polypharmacy demands careful organising. The burden of organising polypharmacy always falls somewhere, whether undertaken by pharmacists as they prepare MCCAs or by patients at home. Greater appreciation among prescribers of the nature and complexity of this work may provide a useful point of departure for tackling the key issue that sustains it: polypharmacy.
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Affiliation(s)
- Deborah Swinglehurst
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nina Fudge
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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The Subjective Experience of Using Medications: What We Know and the Paths Forward. PHARMACY 2021; 9:pharmacy9010050. [PMID: 33801298 PMCID: PMC8006003 DOI: 10.3390/pharmacy9010050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023] Open
Abstract
Medications can cause bodily changes, where the associated benefits and risks are carefully assessed based on the changes experienced in the phenomenal body. For this reason, the phenomenology of Merleau-Ponty is an important theoretical framework for the study of experience related to the daily use of medications. The aim of this study was to discuss the contribution of a recently developed framework of the general ways people can experience the daily use of medications—resolution, adversity, ambiguity, and irrelevance—and present reflections about the little-understood aspects of this experience. However, some issues raised throughout this article remain open and invite us to further exploration, such as (1) the coexistence of multiple ways of experiencing the use of medications, by the same individual, in a given historical time; (2) the cyclical structure of this experience; (3) the impact of habit and routine on the ways of experiencing the daily use of medications; and (4) the contribution of the concept of existential feelings to this experience and its impact on patients’ decision-making. Therefore, the experience with the daily use of medications is a complex and multifaceted phenomenon that directs the decision-making process of patients, impacting health outcomes.
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Fonseca Ribeiro Filardi A, De Araújo Medina Mendonça S, Ramalho de Oliveira D. O SER HUMANO É ASSIM, SOFRE, MAS ALGUNS DIAS SÃO PIORES: A PERCEPÇÃO DOS PACIENTES PARA O INÍCIO DO USO DOS MEDICAMENTOS PSICOTRÓPICOS. PSICOLOGIA EM ESTUDO 2021. [DOI: 10.4025/psicolestud.v26i0.46557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O processo de medicalização da nossa sociedade, na atualidade, acontece em várias direções, indicando que todo e qualquer tipo de mal-estar pode ser tratado com medicamentos. O objetivo da pesquisa foi compreender o início do uso dos psicotrópicos para superar os problemas enfrentados no cotidiano. Entrevistas em profundidade foram realizadas com 19 pessoas sobre os problemas que levaram ao início do uso de medicamentos psicotrópicos. Este estudo utilizou os pressupostos filosóficos de Heidegger e o tratamento de dados conforme proposto por Max van Manen. A análise desvelou o tema ‘O ser humano é assim, a gente sofre, mas alguns dias são piores’, que diz respeito às dificuldades vividas que desencadearam os sentimentos de raiva, ansiedade, estresse, tristeza e angústia, levando ao uso dos medicamentos psicotrópicos. A vivência das dificuldades enfrentadas na vida foi apontada como principal motivo para o início do uso do medicamento, como forma de preservar a saúde mental.
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Rathbone AP, Jamie K, Todd A, Husband A. A qualitative study exploring the lived experience of medication use in different disease states: Linking experiences of disease symptoms to medication adherence. J Clin Pharm Ther 2020; 46:352-362. [PMID: 33151549 DOI: 10.1111/jcpt.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN Medication non-adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high-mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control. OBJECTIVE To explore patients' lived experiences of medication adherence. METHODS Participants were recruited from community pharmacies and general practices. Forty-one semi-structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications. RESULTS Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short-term episodes of non-adherence were unlikely to lead to negative health outcomes but may result in negative social consequences. DISCUSSION The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications. WHAT IS NEW There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short-term episodes of non-adherence were normalized by healthcare professionals. CONCLUSION Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence.
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Affiliation(s)
- Adam Pattison Rathbone
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
| | | | - Adam Todd
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Pharmacy Department, Newcastle Upon Tyne Hospitals NHS, Foundation Trust, Newcastle upon Tyne, UK
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Jamie K, Sharples G. The Social and Material Life of Antimicrobial Clay: Exploring Antimicrobial Resistance, Medicines' Materiality, and Medicines Optimization. FRONTIERS IN SOCIOLOGY 2020; 5:26. [PMID: 33869434 PMCID: PMC8022547 DOI: 10.3389/fsoc.2020.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 06/12/2023]
Abstract
While sociologists have made significant theoretical contributions to the antimicrobial resistance (AMR) debate, little attention has been given to the antimicrobial products themselves. Here we advocate a significant new direction which centers on the social and material life of antimicrobials, specifically on what they are made from and how this affects their use. This focus is timely because, in the context of declining efficacy of biomedical antibiotics, diverse materials are increasingly taking center stage in research and drug discovery as potential agents for new antimicrobial treatments. Of particular significance are natural antimicrobials, such as plants, honey and clay, whose antimicrobial potential is well-documented and which are increasingly moving into mainstream antimicrobial research. Alongside this biomedical focus, we suggest that the social and material lives of these antimicrobial materials require attention to (i) highlight the ways they have been, and continue to be, used in diverse cultures globally, (ii) explore ways we might theorize these materials within wider AMR debates, and (iii) examine the impact of antimicrobials' materiality on their use by patients. This article takes the example of clay, whose antimicrobial properties are well-established and which has been used to treat wounds and gastrointestinal problems for millennia. We first locate clay as an exemplar of a wider shift toward natural products drug discovery in pharmaceutical science and antimicrobial research. We then offer a number of theoretical "ways in" for sociologists to begin making sense of clay as it comes under the western biomedical gaze. We map these conceptual lenses on to clay's physical and symbolic mobility from its use in the global south into western biomedical research and commercialization. We particularly concentrate on post-colonial theory as a means to understand clay's movement from global south to north; laboratory studies to examine its symbolic transformation to a black-boxed antimicrobial artifact; and valuation practices as a lens to capture its movement from the margins to the mainstream. We finish by reflecting on the importance of materiality in addressing optimal use of medicines and by advocating an interdisciplinary approach to AMR which positions sociology as a key contributor to AMR solutions.
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Affiliation(s)
- Kimberly Jamie
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Gary Sharples
- Department of Biosciences, Durham University, Durham, United Kingdom
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Abstract
AbstractThis article examines how older adults make decisions about their medications through interconnected axes of trust that operate across social networks. Trust is negotiated by older adults enrolled in a deprescribing programme which guides them through the process of reducing medications to mitigate risks associated with polypharmacy. Habermas’ work on the significance of communicative action in negotiating trust within social relationships informs our analysis, specifically in-depth semi-structured interviews with older adults about their medication use and the role of social networks in managing their health. Participants were age 70+ and experiencing polypharmacy. Our analysis discusses the social nature of medication practices and the importance of social networks for older adults’ decision-making. Their perspective reflects the critique of late-modern society put forward by Habermas. Negotiating trust in pharmaceutical decision-making requires navigating tensions across and between system networks (health-care professionals) and life-world networks (family and friends). This study contributes to our knowledge of how distinct forms of trust operate in different social spheres, setting the context for the way health-care decisions are made across social networks. Our analysis reinforces the need for older adults to engage meaningfully in health-care decision-making such that a convergence between system-world and life-world structures is encouraged. This would improve deprescribing programmes’ efficacy as older adults optimise their medication use and improve overall quality of life.
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Ross A, Gillett J. Confronting Medicine's Dichotomies: Older Adults' Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing. QUALITATIVE HEALTH RESEARCH 2020; 30:448-457. [PMID: 31451052 DOI: 10.1177/1049732319868981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To address the risks associated with polypharmacy, health care providers are investigating the feasibility of deprescribing programs as part of routine medical care to reduce medication burden to older adults. As older adults are enrolled in these programs, they are confronted with two dominant and legitimate accounts of medications, labeled the medication paradox: medications keep you healthy but they might be making you sick. We investigated how the medication paradox operates in the lives of older adults. In-depth qualitative interviews were conducted and analyzed with older adults aged 70+ to identify the various paradoxes that seniors live through regarding their medications and the narratives that they engage to negotiate these contradictions. Older adults were found to have established interpretative repertoires to make sense of the incongruent narratives of the medication paradox. In this article, we demonstrate older adults' efforts to carve out their unique place in the dichotomized institution of medicine.
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Affiliation(s)
- Alison Ross
- McMaster University, Hamilton, Ontario, Canada
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Leung BMY, Kellett P, Youngson E, Hathaway J, Santana M. Trends in psychiatric disorders prevalence and prescription patterns of children in Alberta, Canada. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1565-1574. [PMID: 31129714 DOI: 10.1007/s00127-019-01714-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the trends in the prevalence and incidence of children with psychiatric disorders, the types of medication prescribed, and the type of physician providing the prescriptions. METHOD This retrospective study linked six population-based administrative databases (2008-2015) in Alberta, Canada. RESULTS The prevalence of paediatric psychiatric disorders increased from 12.6 per 100 population in 2008 to 15.0 per 100 population in 2015, while the incidence rate increased from 2.0 per 100 population to 2.2 per 100 population in the same period. The proportion of patients dispensed any psychiatric medication increased from 21.4% in 2008 to 28.2% in 2015. Over the same period, dispensations for antidepressants increased from 7.0% to 11.2% and stimulants to treat ADHD, from 11.9% to 15.9%. For antidepressants, general practitioners (GPs) wrote the highest proportion of prescriptions (44.3% in 2011-48.1% in 2015), while paediatricians wrote the lowest proportion (8.7% in 2011-11.0% in 2015) and the proportion by psychiatrists decreased from 33.4% in 2011 to 27.2% in 2015. For stimulants to treat ADHD, paediatricians were the most frequent prescribers (36.9% in 2011-39.3% in 2015) followed by GPs as the second most frequent (33.1% in 2011-33.5% in 2015), while psychiatrists were the least likely to prescribe stimulants for ADHD. CONCLUSION The increasing trend of psychiatric diagnoses and medication prescriptions in the paediatric population is evident using population-based administrative databases. The lack of safety and adverse consequences of medication use in this cohort warrants additional monitoring data.
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Affiliation(s)
- Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Peter Kellett
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Erik Youngson
- Health Research Methods and Analytics/SPOR Data Platform, Alberta Health Services, University of Alberta, Edmonton, Canada
| | - Josh Hathaway
- Health Research Methods and Analytics/SPOR Data Platform, Alberta Health Services, University of Alberta, Edmonton, Canada
| | - Maria Santana
- Departments of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Brandão ER. Contraception d’urgence au Brésil : la grammaire du risque dans un pays inégalitaire. ANTHROPOLOGIE ET SANTÉ 2019. [DOI: 10.4000/anthropologiesante.5210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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[Subjectivity and autonomy: meanings and narratives with respect to discontinuing psychiatric drugs]. Salud Colect 2018; 14:513-529. [PMID: 30517560 DOI: 10.18294/sc.2018.1861] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
The objective of this work was to reconstruct the meanings and narratives surrounding the process of discontinuing psychiatric drugs, taking into account the strategies used to abandon these drugs and the processes of construction of identity. In 2015, in-depth semi-structured interviews were conducted individually with five people from Santiago, Chile who had experiences of psychiatric diagnosis, who received treatment with psychiatric drugs during eight o more years, and who discontinued the use of psychiatric drugs for at least one year. The results show the existence of institutional barriers which limit the right to abandon treatment; therefore, people do so autonomously through intimate and personal processes utilizing self-help and social support strategies. At the same time, discontinuing psychiatric drugs implies the construction of a "former user" identity, concentrating knowledge in the figure of expert by experience in the mental health field.
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Schlegel V, Leray E. From Medical Prescription to Patient Compliance: A Qualitative Insight into the Neurologist-Patient Relationship in Multiple Sclerosis. Int J MS Care 2018; 20:279-286. [PMID: 30568565 DOI: 10.7224/1537-2073.2017-043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Approximately 12 disease-modifying treatments are available worldwide for patients with relapsing multiple sclerosis (MS). These recent therapeutic advances have led to major changes in patient and neurologist attitudes toward drug prescription. Herein, we aimed to characterize patient choice regarding treatment for MS and identify how neurologists assess and monitor patient compliance during follow-up. Methods In 29 patients with MS, we observed visits to their neurologist to understand how questions related to compliance were addressed in the doctor-patient relationship. Face-to-face interviews were conducted with 15 of the 29 patients to discuss how they dealt with their drug prescription from a patient-centered perspective. Results Of the 15 patients with MS, nine were offered a choice of treatment. However, we found that neurologists were not always willing to consider the patients' input. Even if physicians attempt to align treatment choice with patient preferences to ensure compliance, preferences are often assumed rather than solicited from patients. Furthermore, patients may be unwilling to make their own treatment decisions. Various ways for neurologists to assess compliance during visits were also identified. Noncompliance can be considered as a way for patients to communicate their preferences and demonstrate involvement in their drug therapy, and it can lead to a renegotiation of the current treatment course. Conclusions These findings suggest that the neurologist-patient relationship has a great influence on patient compliance throughout the MS disease course.
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Abstract
Resumo O artigo aborda alguns resultados da pesquisa Uma investigação socioantropológica no âmbito das farmácias: posição de farmacêuticos e balconistas sobre a contracepção de emergência, uma pesquisa mais ampla, realizada entre 2012 e 2014, com o objetivo de conhecer as concepções e práticas dos farmacêuticos e balconistas sobre a comercialização da contracepção de emergência no país. A coleta de dados entre os farmacêuticos se deu por meio de um questionário on-line, anônimo e autoaplicado, disponível na Plataforma DataSUS/FormSUS, e a divulgação do estudo contou com apoio de órgãos de classe da categoria profissional em foco. Obteve-se a participação voluntária de 383 farmacêuticos, 74,5% pertencentes ao sexo feminino e 25,5%, ao masculino, e a maioria (78,1%) afirmou que os consumidores costumam apresentar dúvidas sobre a contracepção de emergência e seu uso, e procuram os profissionais para saná-las. A maior parte dos entrevistados (88,4%) já buscou informações a respeito da contracepção de emergência, e uma parcela significativa deles (49,9%) desconhece sua distribuição no Sistema Único de Saúde (SUS). O atendimento farmacêutico às consumidoras é problematizado, tendo em vista a importância de incluir esse profissional no debate público nacional sobre o tema e de valorizar sua atuação clínica em farmácias e drogarias. São discutidas, por fim, a questão do uso racional de medicamentos e as possíveis contribuições das ciências sociais ao tema.
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Similarities and differences in the meanings children and their parents attach to epilepsy medications. Soc Sci Med 2017; 177:190-197. [PMID: 28183009 DOI: 10.1016/j.socscimed.2017.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/19/2022]
Abstract
By exploring the meanings children and their parents attached to two household treatments for childhood epilepsy (antiepileptic drugs and emergency medications), this paper broadens our understanding of the ways in which children view their medications and how these views can impact on their adherence to treatment. The paper draws on data collected during 2013 and 2014 from 24 families across the UK that had a child with epilepsy aged 3-13 years. In-depth semi-structured interviews were conducted with the parents and 10 children participated in autodriven photo-elicitation interviews. Parents' and children's perceptions of medications were compared and contrasted and the findings show that although both parents and children viewed medications as an unpleasant necessity, parents' concerns centred on the perceived side effects of medications, whereas the children commented on the process of ingesting medications. Additionally, some of the children had to learn that their medications were a preventative measure, as they originally viewed them as a cure. Furthermore, among the children, it was found that treatment could be seen as either a positive or negative symbol of difference. Lastly, emergency medications were often viewed as a saviour, particularly by parents. Through this analysis, the study shows that the meanings children attached to medications were often linked to the form the medication took and that the way in which children perceived their medications had implications for their adherence; indeed, those who viewed their medications as an unpleasant necessity and those who initially saw their treatment as a cure were most likely to stop taking their medications. Consequently, this paper contributes to the current literature on the meanings individuals attach to treatments by providing the first detailed insight into children's views on epilepsy medications and by illustrating the similarities and differences in children's and parents' perspectives.
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Newman C, Persson A, Ellard J. ‘We just don’t know’: ambivalence about treatment strategies in the Australian community-based HIV media. Health (London) 2016; 10:191-210. [PMID: 16513660 DOI: 10.1177/1363459306061788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The community-based HIV media in Australia provide a unique arena for the negotiation of competing models of medicine between activists, clinicians, government and people living with HIV/AIDS. This article examines how these media have interpreted developments in HIV treatment strategies since the introduction of new treatments in 1996, and identifies the discursive elements employed in journalistic constructions of the temporality and character of HIV medicine. A discourse of ambivalence recurs throughout this journalism, framing the negotiated shifts in treatment strategies as evidence of the uncertainty and unpredictability of HIV medicine. Associated with this discourse are metaphors of medical ambivalence that employ provocative imagery such as fashion, rollercoaster, obstacle course and guessing game to shore up a notion of the volatility of HIV medicine. This article participates in ongoing engagements between the communities and clinicians affected by HIV/AIDS and, more broadly, in the production of knowledge around medicine and the media.
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Affiliation(s)
- Christy Newman
- National Centre in HIV Social Research, University of New South Wales, Australia.
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21
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Rathbone AP, Todd A, Jamie K, Bonam M, Banks L, Husband AK. A systematic review and thematic synthesis of patients' experience of medicines adherence. Res Social Adm Pharm 2016; 13:403-439. [PMID: 27432023 DOI: 10.1016/j.sapharm.2016.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medicines non-adherence continues to be problematic in health care practice. After decades of research, few interventions have a robust evidence-based demonstrating their applicability to improve adherence. Phenomenology has a place within the health care research environment. OBJECTIVE To explore patients' lived experiences of medicines adherence reported in the phenomenonologic literature. METHODS A systematic literature search was conducted to identify peer-reviewed and published phenomenological investigations in adults that aimed to investigate patients' lived experiences of medicines adherence. Studies were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Tool. Thematic synthesis was conducted using a combination of manual coding and NVivo10 [QSR International, Melbourne] coding to aid data management. RESULTS Descriptive themes identified included i) dislike for medicines, ii) survival, iii) perceived need, including a) symptoms and side-effects and b) cost, and iv) routine. Analytic themes identified were i) identity and ii) interaction. CONCLUSIONS This work describes adherence as a social interaction between the identity of patients and medicines, mediated by interaction with family, friends, health care professionals, the media and the medicine, itself. Health care professionals and policy makers should seek to re-locate adherence as a social phenomenon, directing the development of interventions to exploit patient interaction with wider society, such that patients 'get to know' their medicines, and how they can be taken, throughout the life of the patient and the prescription.
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Affiliation(s)
- A P Rathbone
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - A Todd
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - K Jamie
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham DH1 3HN, United Kingdom
| | - M Bonam
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - L Banks
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - A K Husband
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom.
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Gibson K, Cartwright C, Read J. 'In my life antidepressants have been…': a qualitative analysis of users' diverse experiences with antidepressants. BMC Psychiatry 2016; 16:135. [PMID: 27165309 PMCID: PMC4863327 DOI: 10.1186/s12888-016-0844-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/04/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND While mental health professionals have focused on concerns about whether antidepressants work on a neurochemical level it is important to understand the meaning this medication holds in the lives of people who use it. This study explores diversity in the experience of antidepressant users. METHODS One thousand seven hundred forty-seven New Zealand antidepressant users responded to an open-ended question about their experience of antidepressants. This was analysed using content and thematic analysis. RESULTS There was considerable diversity in participants' responses including positive (54 %), negative (16 %) and mixed (28 %) experiences with antidepressants. Those with positive experiences saw antidepressants as a necessary treatment for a 'disease', a life saver, a way of meeting social obligations, dealing with difficult circumstances or a stepping stone to further help. Negative themes described antidepressants as being ineffective, having unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Mixed experience themes showed how participants weighed up the unpleasant side effects against the benefits, felt calmer but less like themselves, struggled to find the one or dosage and felt stuck with continuing on antidepressants when they wished to stop. CONCLUSIONS Mental health professions need to recognize that antidepressants are not a 'one size fits all' solution.
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Affiliation(s)
- Kerry Gibson
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Claire Cartwright
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - John Read
- School of Psychology, University of East London, London, United Kingdom
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Gabe J, Coveney CM, Williams SJ. Prescriptions and proscriptions: moralising sleep medicines. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:627-44. [PMID: 26586293 PMCID: PMC4991279 DOI: 10.1111/1467-9566.12383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble' non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today.
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Affiliation(s)
- Jonathan Gabe
- Centre for Criminology & SociologyRoyal HollowayUniversity of London
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24
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Collin J. On social plasticity: the transformative power of pharmaceuticals on health, nature and identity. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:73-89. [PMID: 26360625 PMCID: PMC5014216 DOI: 10.1111/1467-9566.12342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article proposes a theoretical framework on the role of pharmaceuticals in transforming perspectives and shaping contemporary subjectivities. It outlines the significant role drugs play in three fundamental processes of social transformation in Western societies: medicalisation, molecularisation and biosocialisation. Indeed, drugs can be envisaged as major devices of a pharmaceutical regime, which is more akin to the notion of dispositif, as used by Foucault, than to the sole result of high-level scheming by powerful economic interests, a notion which informs a significant share of the literature. Medications serve as a key vector of the transformation of perspective (or gaze) that characterises medicalisation, molecularisation and biosocialisation, by shifting our view on health, nature and identity from a categorical to a dimensional framework. Hence, central to this thesis is that the same underlying mechanism is at work. Indeed, in all three processes there is an evolving polarity between two antinomic categories, the positions of which are constantly being redefined by the various uses of drugs. Due to their concreteness, the fluidity of their use and the plasticity of the identities they authorise, drugs colonise all areas of contemporary social experiences, far beyond the medical sphere. A video abstract of this article can be found at: https://www.youtube.com/watch?v=djIBY7DHKW4&feature=youtu.be.
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Affiliation(s)
- Johanne Collin
- Research Group on Medications as Social Objects and Faculty of PharmacyUniversite de MontrealCanada
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Ridge D, Kokanovic R, Broom A, Kirkpatrick S, Anderson C, Tanner C. "My dirty little habit": Patient constructions of antidepressant use and the 'crisis' of legitimacy. Soc Sci Med 2015; 146:53-61. [PMID: 26498732 DOI: 10.1016/j.socscimed.2015.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
Abstract
Discontents surrounding depression are many, and include concerns about a creeping appropriation of everyday kinds of misery; divergent opinions on the diagnostic category(ies); and debates about causes and appropriate treatments. The somewhat mixed fortunes of antidepressants - including concerns about their efficacy, overuse and impacts on personhood - have contributed to a moral ambivalence around antidepressant use for people with mental health issues. Given this, we set out to critically examine how antidepressant users engage in the moral underpinnings of their use, especially how they ascribe legitimacy (or otherwise) to this usage. Using a modified constant comparative approach, we analyzed 107 narrative interviews (32 in UKa, 36 in UKb, 39 in Australia) collected in three research studies of experiences of depression in the UK (2003-4 UKa, and 2012 UKb) and in Australia (2010-11). We contend that with the precariousness of the legitimacy of the pharmaceutical treatment of depression, participants embark on their own legitimization work, often alone and while distressed. We posit that here, individuals with depression may be particularly susceptible to moral uncertainty about their illness and pharmaceutical interventions, including concerns about shameful antidepressant use and deviance (e.g. conceiving medication as pseudo-illicit). We conclude that while people's experiences of antidepressants (including successful treatments) involve challenges to illegitimacy narratives, it is difficult for participants to escape the influence of underlying moral concerns, and the legitimacy quandary powerfully shapes antidepressant use.
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Affiliation(s)
- Damien Ridge
- Department of Psychology, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK.
| | - Renata Kokanovic
- School of Social Sciences, Clayton Campus, Menzies Building, Wellington Road, Clayton, Victoria 3800, Australia.
| | - Alex Broom
- School of Social Sciences, University of New South Wales, Sydney 2052, Australia.
| | - Susan Kirkpatrick
- Health Experiences Research Group, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Claire Anderson
- School of Pharmacy, University Park, Nottingham University, Nottingham NG7 2RD, UK.
| | - Claire Tanner
- School of Social Sciences, Clayton Campus, Menzies Building, Wellington Road, Clayton, Victoria 3800, Australia.
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Abstract
Sleep disturbances are common among older women; however, little is known about sleep experiences among chronic benzodiazepine users. The experience of sleep, sleep troubles, and management of sleep problems were explored through semistructured interviews with 12 women aged 65-92 who had used a benzodiazepine for three months or longer to treat a sleep disturbance. Themes that emerged from an interpretive phenomenological analysis included multiple reasons for sleep disruptions (health problems, mental disturbances, and sleeping arrangements), opposing effects of benzodiazepines on sleep (helps or does not work), and several supplemental sleep strategies (modification of the environment, distraction, and consumption).
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Affiliation(s)
- Sarah L Canham
- a Gerontology Research Centre, Simon Fraser University , Vancouver , British Columbia , Canada
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27
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Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open 2014; 4:e006544. [PMID: 25488097 PMCID: PMC4265124 DOI: 10.1136/bmjopen-2014-006544] [Citation(s) in RCA: 459] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. DESIGN A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. SETTING All healthcare settings. PARTICIPANTS Medical and non-medical prescribers of medicines to adults. OUTCOMES Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. RESULTS 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. CONCLUSIONS A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the risk of iatrogenic harm.
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Affiliation(s)
- Kristen Anderson
- Centre of Research Excellence in Quality & Safety in Integrated Primary-Secondary Care, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Charming Institute, Camp Hill, Brisbane, Queensland, Australia
| | - Danielle Stowasser
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Freeman
- Charming Institute, Camp Hill, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian Scott
- Centre of Research Excellence in Quality & Safety in Integrated Primary-Secondary Care, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Abstract
The body is a central feature of pharmacy practice. Despite this and the increased sociological focus on bodies in health and social care practice, the nature of the body and the work undertaken upon it in pharmacy have not been explored. Drawing on semi-structured interviews with hospital and community pharmacists, this article explores the ways in which bodies are constructed and managed in these two practice contexts. It is argued that pharmacists see patients' bodies in particular ways given their expertise in medicines, which is conceptualised here as the pharmacy gaze. The notion of complexity, as a way of constructing the body, and the generation of algorithmic bodies, as a way of managing this complexity, are shown to be central to the pharmacy gaze in both hospital and community contexts. In hospitals, complexity was located in a singular body, that is, increasingly rationalised to reduce costs and toxicity. In community practice, complexity arose from the multiplicity of bodies with which pharmacists interact in their multifaceted role as retailers, dispensers and public health practitioners. The article concludes by reflecting on the ways in which current UK health policy may broaden the body work that English pharmacists undertake.
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Affiliation(s)
- Kimberly Jamie
- School of Applied Social Sciences, Durham University, Durham
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29
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Busfield J. Assessing the overuse of medicines. Soc Sci Med 2014; 131:199-206. [PMID: 25464876 DOI: 10.1016/j.socscimed.2014.10.061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 01/02/2023]
Abstract
The use of medicines has increased markedly in many countries over recent years, providing clear evidence of the increasing 'pharmacaeuticalisation' of society. This paper contributes to the sociological analysis of pharmaceuticalisation by starting to explore how we can begin to make judgements as to when and to what extent some medicines are being overused--an important aspect that, rather surprisingly, has not so far been the focus of attention those analysing the process. It considers the World Health Organisation's criteria for the 'rational' use of medicines, pointing to some of the issues they raise. It then develops a typology of over and underuse derived from these criteria. This provides a framework for the discussion of assessing overuse that focuses in particular on the widespread and increasing use of medicines that are not very effective for the conditions for which they are prescribed, and their use where the issue of clinical need is in doubt. Some of the factors that encourage overuse are also considered.
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Affiliation(s)
- Joan Busfield
- University of Essex, Dept of Sociology, Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
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Shepherd A, Shorthouse O, Gask L. Consultant psychiatrists' experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry 2014; 14:127. [PMID: 24886121 PMCID: PMC4009071 DOI: 10.1186/1471-244x-14-127] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 03/24/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Shared decision making represents a clinical consultation model where both clinician and service user are conceptualised as experts; information is shared bilaterally and joint treatment decisions are reached. Little previous research has been conducted to assess experience of this model in psychiatric practice. The current project therefore sought to explore the attitudes and experiences of consultant psychiatrists relating to shared decision making in the prescribing of antipsychotic medications. METHODS A qualitative research design allowed the experiences and beliefs of participants in relation to shared decision making to be elicited. Purposive sampling was used to recruit participants from a range of clinical backgrounds and with varying length of clinical experience. A semi-structured interview schedule was utilised and was adapted in subsequent interviews to reflect emergent themes.Data analysis was completed in parallel with interviews in order to guide interview topics and to inform recruitment. A directed analysis method was utilised for interview analysis with themes identified being fitted to a framework identified from the research literature as applicable to the practice of shared decision making. Examples of themes contradictory to, or not adequately explained by, the framework were sought. RESULTS A total of 26 consultant psychiatrists were interviewed. Participants expressed support for the shared decision making model, but also acknowledged that it was necessary to be flexible as the clinical situation dictated. A number of potential barriers to the process were perceived however: The commonest barrier was the clinician's beliefs regarding the service users' insight into their mental disorder, presented in some cases as an absolute barrier to shared decision making. In addition factors external to the clinician - service user relationship were identified as impacting on the decision making process, including; environmental factors, financial constraints as well as societal perceptions of mental disorder in general and antipsychotic medication in particular. CONCLUSIONS This project has allowed identification of potential barriers to shared decision making in psychiatric practice. Further work is necessary to observe the decision making process in clinical practice and also to identify means in which the identified barriers, in particular 'lack of insight', may be more effectively managed.
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Affiliation(s)
| | | | - Linda Gask
- University of Manchester, Manchester, UK
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31
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Salter C, McDaid L, Bhattacharya D, Holland R, Marshall T, Howe A. Abandoned acid? Understanding adherence to bisphosphonate medications for the prevention of osteoporosis among older women: a qualitative longitudinal study. PLoS One 2014; 9:e83552. [PMID: 24392086 PMCID: PMC3879247 DOI: 10.1371/journal.pone.0083552] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is significant morbidity and mortality caused by the complications of osteoporosis, for which ageing is the greatest epidemiological risk factor. Preventive medications to delay osteoporosis are available, but little is known about motivators to adhere to these in the context of a symptomless condition with evidence based on screening results. AIM To describe key perceptions that influence older women's adherence and persistence with prescribed medication when identified to be at a higher than average risk of fracture. DESIGN OF STUDY A longitudinal qualitative study embedded within a multi-centre trial exploring the effectiveness of screening for prevention of fractures. SETTING Primary care, Norfolk. United Kingdom. METHODS Thirty older women aged 70-85 years of age who were offered preventive medication for osteoporosis and agreed to undertake two interviews at 6 and 24 months post-first prescription. RESULTS There were no overall predictors of adherence which varied markedly over time. Participants' perceptions and motivations to persist with medication were influenced by six core themes: understanding adherence and non-adherence, motivations and self-care, appraising and prioritising risk, anticipating and managing side effects, problems of understanding, and decision making around medication. Those engaged with supportive professionals could better tolerate and overcome barriers such as side-effects. CONCLUSIONS Many issues are raised following screening in a cohort of women who have not previously sought advice about their bone health. Adherence to preventive medication for osteoporosis is complex and multifaceted. Individual participant understanding, choice, risk and perceived need all interact to produce unpredictable patterns of usage and acceptability. There are clear implications for practice and health professionals should not assume adherence in any older women prescribed medication for the prevention of osteoporosis. The beliefs and motivations of participants and their healthcare providers regarding the need to establish acceptable medication regimes is key to promoting and sustaining adherence.
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Affiliation(s)
- Charlotte Salter
- Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Lisa McDaid
- Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Debi Bhattacharya
- School of Chemistry and Pharmacy, University of East Anglia, Norwich, Norfolk. United Kingdom
| | - Richard Holland
- Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Tarnya Marshall
- Rheumatology Department, Norfolk & Norwich University Foundation Trust Hospital. Norwich, Norfolk. United Kingdom
| | - Amanda Howe
- Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom
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Houborg E. Methadone, a contested substance: Danish methadone policy in the 1970s. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e73-80. [PMID: 24120441 DOI: 10.1016/j.drugpo.2013.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 06/07/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND During the 1970s in Denmark, there was a great deal of controversy about the role of methadone in Danish drug policy. At stake were not just epistemological issues about how to explain drug problems or indeed technical issues about the best possible treatment for such problems, but also social issues about how drug problems and drug treatment affected and were affected by social change. The paper uses an analytical framework in which drugs are co-constructed with their social worlds. It uses this framework to investigate how conflicts emerged about the different ways of conceiving of the relationship between methadone and Danish society. METHODS Documentary data from the archives of a pressure group of parents of children with drug problems, the archives of an addiction doctor, newspaper articles, and policy documents from that time were coded in order to identify and analyze central controversies. RESULTS The methadone controversy of the 1970s was not just about the best treatment methods, but also a matter of the future of the Danish welfare state. The nation debated whether it should medicalise a social problem or solve it through social reform. CONCLUSION Drug treatment is not just a technical issue, but also a political issue and this needs to be accounted for when making drug policy.
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Affiliation(s)
- Esben Houborg
- Center for Alcohol and Drug Research, Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 10, Building 1322, DK-8000 Aarhus C, Denmark.
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Delbaere M. Metaphors and myths in pharmaceutical advertising. Soc Sci Med 2013; 82:21-9. [DOI: 10.1016/j.socscimed.2013.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 01/11/2013] [Accepted: 01/18/2013] [Indexed: 11/27/2022]
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Cunha KOA, Renovato RD, Descovi MS, Vesco JRD, Silva CAD, Missio L, Alvarenga MRM. Representações sobre uso racional de medicamentos em equipes da Estratégia Saúde da Família. Rev Esc Enferm USP 2012; 46:1431-7. [DOI: 10.1590/s0080-62342012000600021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 03/13/2012] [Indexed: 11/22/2022] Open
Abstract
Pesquisa qualitativa, descritiva e exploratória, cujo objetivo foi conhecer e compreender as representações sobre o uso racional de medicamentos em três equipes da Estratégia Saúde da Família (ESF) da zona urbana do município de Dourados-MS, tendo como aporte teórico o conceito de representações de Stuart Hall. Como técnica utilizaram-se os grupos focais, e a avaliação de dados deu-se a partir da análise temática, modalidade da análise de conteúdo. Participaram da pesquisa 26 componentes. Verificou-se que os profissionais destacaram papel curativo e aspectos negativos dos medicamentos. Também apresentaram representações acerca dos pacientes, relatando que não compreendem o uso correto dos medicamentos, não aderem ao tratamento e se automedicam. Nota-se a necessidade de implantação de práticas educativas em saúde para promoção do uso racional de medicamentos.
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Introduction: Sociology and the Shifting Landscape of Addiction. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/s1057-6290(2012)0000014003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Flick U, Garms-Homolová V, Röhnsch G. "And mostly they have a need for sleeping pills": physicians' views on treatment of sleep disorders with drugs in nursing homes. J Aging Stud 2012; 26:484-94. [PMID: 22939545 DOI: 10.1016/j.jaging.2012.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/21/2012] [Accepted: 07/03/2012] [Indexed: 11/16/2022]
Abstract
The percentage of nursing home residents treated with hypnotic medications is high, as many authors report, despite the fact that such medications are almost always associated with undesirable effects for old people. This article takes a closer look at nursing home physicians' views of prescriptions when treating sleep disorders of nursing home residents. How do physicians characterize the treatment strategy for residents suffering from sleep disorders? How do they balance the benefits and risks of the hypnotic medication? Under what circumstances do they accept negative consequences? To answer these questions, N=20 physicians (aged 36 to 68 years) in 16 nursing homes in a German city were interviewed. The physicians were either employed by nursing homes or worked on a contract basis. Comparative categorization of the data produced a typology across cases. Three interpretative patterns concerning the use of drugs for treating sleep disorders were identified--"by request," "ambivalence," and "reflected prescription." Differences between them were determined by the significance of residents' wishes, neglect of risks, particularly that of addiction, and the attempt to balance benefits and disadvantages. The study showed deficits in professional management of sleep disorders in nursing homes.
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Affiliation(s)
- Uwe Flick
- Alice Salomon University of Applied Sciences, Berlin, Germany; University of Vienna, Austria.
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37
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Abstract
This article uses the concept of “political pharmacology” to show that drugs are complex and mutable entities, the constitution of which is as much a political (power) issue as it is a technical one. The article analyzes the negotiations and struggles that have been involved in the constitution of methadone and heroin as maintenance drugs in Denmark. Danish drug policy on medical-maintenance treatment was for many years dominated by a medico-administrative technocracy. But from the mid-1990s, this technocracy, and the way it defined maintenance treatment and maintenance drugs, was challenged by drug users and other actors. They were, among other things, dissatisfied with the medical constitution of maintenance drugs as “stabilizing medications” and demanded that the drugs should also be allowed to function as “intoxicating substances.”
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de Melo CM, de Oliveira DR. [The use of apetite inhibitors by women: an insight based on the gender perspective]. CIENCIA & SAUDE COLETIVA 2011; 16:2523-32. [PMID: 21655726 DOI: 10.1590/s1413-81232011000500022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/10/2010] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to understand the motives that lead adult women to use appetite inhibitors and to establish, from a gender perspective, how these women relate to their own bodies. It was structured around the principles of qualitative research, and the methods of data collection were semi-structured interviews and direct observation. The informants were six women who used appetite inhibitors. The results indicated that images, publicity and social networks contribute significantly to the creation of new standards of physical appearance as well as lifestyles, which establish appearance (a slim body) and a happy marriage as the desired model. The slim body is represented as something able to alter the temperament of the individual, in other words a fat person is an unhappy person and a slim person is a happy person. The study shows that it is in the body per se that the social role destined for women is produced and reproduced.
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Harker M, Harker D. Direct-to-consumer-advertising of prescription medicines: a theoretical approach to understanding. Leadersh Health Serv (Bradf Engl) 2010; 20:76-84. [PMID: 20690467 DOI: 10.1108/17511870710745411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The pharmaceutical industry is a leader in research and development investment. New treatments need to be communicated to the market, and consumers are increasingly interested in learning about new drugs. Direct to consumer advertising of prescription medicines (DTCA) is a controversial practice where many of the arguments for and against are not supported by strong evidence. This paper aims to contribute to a research agenda that is forming in this area. DESIGN/METHODOLOGY/APPROACH The paper reports on a systematic review that was conducted and applies accepted theoretical models to the DTCA context. The systematic review methodology is widely accepted in the medical sector and is successfully applied here in the marketing field. FINDINGS The hierarchy of effects model is specifically applied to DTCA with a clear emphasis on consumer rights, empowerment, protection and knowledge. ORIGINALITY/VALUE This paper provides healthcare practitioners with insight into how consumers process DTCA messages and provides guidance into how to assist in this message processing.
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Affiliation(s)
- Michael Harker
- Faculty of Business, University of the Sunshine Coast, Maroochydore South, Queensland, Australia
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Évolution de la pratique pharmaceutique en contexte de redéfinition des territoires de la santé : ce que les sciences humaines et sociales peuvent apporter à la formation du pharmacien. ANNALES PHARMACEUTIQUES FRANÇAISES 2010; 68:205-11. [DOI: 10.1016/j.pharma.2010.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 04/07/2010] [Accepted: 04/12/2010] [Indexed: 11/20/2022]
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Thomas F. Transnational health and treatment networks: Meaning, value and place in health seeking amongst southern African migrants in London. Health Place 2010; 16:606-12. [DOI: 10.1016/j.healthplace.2010.01.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 01/19/2010] [Accepted: 01/24/2010] [Indexed: 11/15/2022]
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'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London. Soc Sci Med 2010; 70:736-43. [PMID: 19963309 DOI: 10.1016/j.socscimed.2009.10.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/06/2009] [Accepted: 10/09/2009] [Indexed: 11/22/2022]
Abstract
In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and 'expert' patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008-2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use 'traditional' medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally.
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A systematic review of long-term studies of drug treated and non-drug treated depression. J Affect Disord 2009; 118:9-18. [PMID: 19249104 DOI: 10.1016/j.jad.2009.01.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 01/25/2009] [Accepted: 01/27/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND The evidence base for long term antidepressant pharmacotherapy is limited. This review describes long-term outcomes of antidepressant-treated depression during the modern pharmacological era (post-1988). METHODS Review of Medline, PsycInfo, EMBASE, and the Cochrane Library using keywords and controlled vocabulary terms for long-term outcome studies (10 years or more) of antidepressant-treated cohorts (with at least 1 follow-up assessment post 1988) and non-drug treated cohorts (no time frame). Manual search of references of included articles. RESULTS Searches resulted in 24 publications on 12 naturalistic studies of antidepressant-treated cohorts (n=3901 at final follow-up). Most participants were White females with one inpatient stay. Recurrence of depression ranged from 40% to 85%. About one-quarter of individuals achieved a rating of well or improved, as many as experienced systematically poor outcomes. Frequency, duration, and severity of episodes varied substantially. Functional and social outcomes were infrequently measured. Few studies adequately assessed treatments. Outcomes for 3 non-drug treated samples with 1160 patients were no worse than outcomes achieved in antidepressant-treated cohorts. LIMITATIONS Heterogeneity of study designs and outcome definitions, and crude measures of pharmacotherapy precluded a statistical analysis. CONCLUSIONS Long-term outcomes in depression appear generally poor. No clear relationship emerged between drug treatment and positive outcomes. A lack of evidence from these long-term naturalistic studies of depression precludes any recommendation for maintenance antidepressant pharmacotherapy. Given its public health significance, more data is needed to address this area.
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McMullen LM, Herman J. Women's accounts of their decision to quit taking antidepressants. QUALITATIVE HEALTH RESEARCH 2009; 19:1569-79. [PMID: 19843965 DOI: 10.1177/1049732309349936] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Over the past 15 years, the rates at which antidepressants are prescribed have increased dramatically. Adherence, however, is often low and considered to be problematic. Using a discursive approach to analyzing interviews with six Canadian women who chose unilaterally to discontinue their use of antidepressants, we focus on three rhetorical strategies used to justify their actions: (a) referencing the actual or potential effects of antidepressants, (b) positioning lay knowledge as superior to expert medical knowledge, and (c) denigrating medical authorities. We argue that these women drew on the responsible-use-of-drugs framework as a way of positioning themselves against potential charges of having engaged in an irrational act.
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Fullagar S. Negotiating the neurochemical self: anti-depressant consumption in women's recovery from depression. Health (London) 2009; 13:389-406. [PMID: 19491233 DOI: 10.1177/1363459308101809] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anti-depressant treatment can be viewed as an exercise of biopower that is articulated through policies and practices aimed at the reduction of depression, population healthcare costs and effects on labour force productivity. Drawing upon a feminist governmentality perspective, this article examines the discourses that shaped women's experiences of anti-depressant medication in an Australian qualitative study on recovery from depression. The majority of women had been prescribed anti-depressants to treat a chemical imbalance in the brain, manage symptoms and restore normal functioning. One-third of participants identified anti-depressants as helpful in their recovery, while two-thirds were either highly ambivalent about, or critical of, medication as a solution to depression. Thirty-one women who identified the ;positive' benefits of anti-depressants actively constituted themselves as biomedical consumers seeking to redress a chemical imbalance. The problem of depression, the emergence of molecular science and the push for pharmacological solutions are contributing to the discursive formation of new subject positions - such as the neurochemically deficient self. Three themes were identified in relation to medication use, namely restoring normality, signifying recovery success and control/uncertainty. Anti-depressant medication offered women a normalized pathway to successful recovery that stood in stark contrast to the biologically deficient and morally failing self. These women's stories importantly reveal the gender relations and paradoxes arising from biopolitical technologies that shape selfhood for women in advanced liberal societies.
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Affiliation(s)
- Simone Fullagar
- Department of Tourism, Leisure, Hotel and Sport Management, Griffith University, Queensland, Australia.
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46
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McCoy L. Time, self and the medication day: a closer look at the everyday work of 'adherence'. SOCIOLOGY OF HEALTH & ILLNESS 2009; 31:128-46. [PMID: 19170973 DOI: 10.1111/j.1467-9566.2008.01120.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This article examines the everyday work of participating in pharmaceutical treatment for HIV infection in the context of urgent calls for adherence. Drawing on interviews and focus-group conversations with people taking antiretroviral drugs, the analysis explicates the work that goes into striving for adherence. What comes into view is a form of time work that brings about a temporary alignment between the inner experience of time, standard clock time, and the requirements of the medication schedule. Time work is largely cognitive; the pills, however, must actually be swallowed to complete the dose, occasioning, for some people, additional work to suppress or refashion emotional responses of anger and resistance. Both the time work and the emotional work of taking antiretroviral drugs draw people into forms of self work, including self-examination and self-adjustment, as they develop strategies for 'doing adherence'.
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Affiliation(s)
- Liza McCoy
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada.
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Paddison A, Olsen K. Painkiller purchasing in the UK. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2008. [DOI: 10.1108/17506120810922330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mykhalovskiy E. Beyond decision making: class, community organizations, and the healthwork of people living with HIV/AIDS. Contributions from institutional ethnographic research. Med Anthropol 2008; 27:136-63. [PMID: 18464127 DOI: 10.1080/01459740802017363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The consolidation of antiretroviral therapy as the primary biomedical response to HIV infection in the global North has occasioned a growing interest in the health decision making of people living with HIV (PHAs). This interest is burdened by the weight of a behaviorist theoretical orientation that limits decision making to individual acts of rational choice. This article offers an alternative way to understand how PHAs come to take (or not take) biomedical treatments. Drawing on institutional ethnographic research conducted in Toronto, Canada, it explores how the "healthwork" of coming to take (or not take) treatments is organized by extended relations of biomedical knowledge. The article focuses on two aspects of the knowledge relations of coming to take pharmaceutical medications that transcend the conceptual and relational terrain of rational decision-making perspectives. First, it explores disjunctures between the everyday healthwork of poor, socially marginalized PHAs and the terms of biomedical decision making. Second, it investigates the knowledge-mediating activities of community-based organizations that help mitigate those disjunctures.
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Affiliation(s)
- Eric Mykhalovskiy
- Department of Sociology, Vari Hall, York University, Toronto, Ontario, Canada.
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Wong WKT, Ussher J. How do subjectively-constructed meanings ascribed to anti-HIV treatments affect treatment-adherent practice? QUALITATIVE HEALTH RESEARCH 2008; 18:458-468. [PMID: 18354045 DOI: 10.1177/1049732308314852] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Anti-HIV treatment-adherent practice is a significant issue in HIV medical discourses on effective disease treatment and management. Findings from research studies into treatment (non)adherence have positioned the act as a medical issue that could be remedied by behavioral strategies. The present study, conducted in Sydney, Australia, aims to examine treatment-(non)adherent practice as a subjective expression of meanings ascribed to treatments by employing a narrative analytical approach informed by poststructuralist epistemology. The findings indicate that people with HIV negotiate and position treatments in particular ways that lead to multiple and varied understanding of treatments. The ways treatments are positioned in their everyday lives suggest that meanings ascribed to treatments impact on the way individuals negotiate demands embedded in the medically-constructed practice of adherence.
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Affiliation(s)
- W K Tim Wong
- Gender, Culture and Health Research Unit, PsyHealth, School of Psychology, University of Western Sydney, New South Wales, Australia.
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50
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Smardon R. `I'd rather not take Prozac': stigma and commodification in antidepressant consumer narratives. Health (London) 2008; 12:67-86. [DOI: 10.1177/1363459307083698] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores the idea that narrative is the primary vehicle through which antidepressant consumers negotiate their sense of identity and reality. Antidepressant consumers represent a unique consumer culture because of the stigma that society attaches to mental illness. Recent media attention, including direct to consumer (DTC) advertising, appears to decrease the stigma surrounding antidepressant use while at the same time commodifying and branding them for mass consumption. Antidepressant consumers must negotiate the threat of stigma and the threat of commodification through the process of constructing narratives. Exploring the narrative process of identity negotiation reveals how the interconnected cultural processes of stigma and commodification are undergoing historical shifts. Among these shifts are the intensification of branding and an expansion of consumer culture. Implications for health promotion and further research are discussed.
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