Abstract
Objectives
The objectives of this study were to determine the perceptions of European physicians, nurses, and pharmacists about the extent of nonadherence by patients in their country relative to their perception of nonadherence by their own patients, and to investigate the occurrence of optimistic bias about medication adherence. The study explored a key cognitive bias for prevalence and likelihood estimates in the context of health care professionals’ beliefs about patients’ use of medicines.
Methods
A cross-sectional online survey of 3,196 physicians (855), nurses (1,294), and pharmacists (1,047) in ten European countries (Austria, Belgium, England, France, Germany, Hungary, the Netherlands, Poland, Portugal, and Switzerland) was used.
Results
Participants differed in their perceptions of the prevalence of medication adherence initiation, implementation, and persistence present in their own patients with a chronic illness in comparison to patients with a chronic illness in general. Health care professionals demonstrated optimistic bias for initiation and persistence with medicine taking, perceiving their own patients to be more likely to initiate and persist with treatment than other patients, but reported significantly lower prevalence of medication adherence levels for their own patients than for patients in general. This finding is discussed in terms of motivational and cognitive factors that may foster optimistic bias by health care professionals about their patients, including heightened knowledge of, and positive beliefs about, their own professional competence and service delivery relative to care and treatment provided elsewhere.
Conclusion
Health care professionals in Europe demonstrated significant differences in their perceptions of medication adherence prevalence by their own patients in comparison to patients in general. Some evidence of optimistic bias by health care professionals about their patients’ behavior is observed. Further social cognitive theory-based research of health care professional beliefs about medication adherence is warranted to enable theory-based practitioner-focused interventions to be tested and implemented.
Acknowledgments
We would like to thank all survey partners for their assistance with data collection across Europe. Austria: Lorenz Auer-Hackenberg, Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna; Univ Lekt Dr Heimo Lagler, Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna; Associate Professor Dr Michael Ramharter, Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna. Belgium: Professor Doctor Veerle Foulon, Faculty of Pharmaceutical Sciences, KU Leuven. France: Fabrice Baton, Kappa Santé; Charlotte Drochon, Kappa Santé; Nathalie Texier, Kappa Santé; Doctor Eric Van Ganse, University of Lyon. Germany: Sabine Breiholz, Drug Commission of German Pharmacists (AMK); Doctor Lilian Krist, Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin; PD Doctor Falk Müller-Riemenschneider, Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin. Hungary: Doctor Balogh Zoltán, President, Hungarian Chamber of Health Professionals; Berend, Dóra, Health Marketing Research Centre, Marketing and Media Institute, Corvinus University, Budapest; Doctor Horváth Tamás, President, Hungarian Chamber of Pharmacists; Doctor Éger István, President, Hungarian Medical Chamber; Doctor Simon Judit, Health Marketing Research Centre, Marketing and Media Institute, Corvinus University, Budapest. The Netherlands: Jan Hermsen, Netherlands Institute for Health Services Research, Utrecht; Doctor Liset van Dijk, Netherlands Institute for Health Services Research, Utrecht. Portugal: Doctor Luis Caldeira, National Authority of Medicines and Health Products (INFARMED), Lisbon; Frederico Saraiva, National Authority of Medicines and Health Products (INFARMED), Lisbon. Switzerland: Professor Doctor Kurt E Hersberger, Department of Pharmaceutical Sciences, University of Basel; Doctor Marie P Schneider, Department of Pharmacy, Policlinique Médicale Universitaire, Lausanne; Esther Spinatsch, Department of Pharmaceutical Sciences, University of Basel; PD Doctor Andreas Zeller, Institute for General Internal Medicine, University of Basel. This study, as part of the ABC project, was funded by the European Commission Seventh Framework programme (FP7 Theme Health, 2007-3.1-5, grant agreement number 223477). The final project report is available at http://abcproject.eu/img/ABC%20Final.pdf.
Author contributions
WC was the principal investigator of the study. WC, CM, SM, SDG, TR, KS, FD, and PK designed the study. PJ analyzed the data. WC, PJ, and SM interpreted the data. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.