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Anthropological approach of adherence factors for antihypertensive drugs

Keywords: Patient adherence , drug therapy , social representations , chronic diseases , hypertension , physicianpatientrelationship , trust , anthropology

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SummaryAim: Uncontrolled hight blood pressure leads clinicians to wonder about adherence degree amongst hypertensive patients. In this context, our study aims to describe and analyse patients experience of antihypertensive drugs, in order to shed light on the multiple social and symbolic logics, forming part of the cultural factors shaping personal medication practices.Methods: The inductive and comprehensive anthropological approach implemented is based on an ethnographical survey (observations of medical consultations and interviews). Semi-structured interviews were conducted with 68 hypertensive patients (39 women and 29 men,between the ages of 40 and 95, of whom 52 were over 60) who had been receiving treatment for over a year. Results: Antihypertensive drug is reinterpreted using popular representations of pathophysiology (the body as a machine). This symbolic dimension eases acceptance of therapy, but leads to a hierarchy forming of other prescribed medicines and of certain therapeutic classes(such as diuretics). Prescription compliance does not solely depend on the patient’s perception of cardiovascular risk, but also on how the patient appropriates the treatment and integrates it into his/her daily life, requiring identification with the product,building commitment and self-control of the treatment(experimentation; command of treatment; control of side effects, of intake, continuity of treatment).A relationship based on trust between the physician and patient is necessary for a prescription to be followed. We have identified three types of relationship: reasoned trust, emotional trust, conceded trust.Conclusion: Consideration and understanding of these pragmatic, symbolic issues by physicians should help practitioners support and advise patients with high blood pressure.Prat Organ Soins 2008;39(1):3-12


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