What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

Abstract

BackgroundOptimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD). Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure.MethodsTwelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons) who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services.ResultsFailing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients.ConclusionsTreatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.

Case report of patient experience influenced by inadequate interactions between primary, secondary, and tertiary healthcare services in the south of Saudi Arabia

“…For example, none of the physicians involved in this patient experience asked IG about his occupation, suggesting inadequacy in history taking. In a Norwegian study assessing failure of treatment of GERD, it was reported that failure of interaction of physicians between different levels of healthcare was a leading contributor in treatment failure . This was similar to what was observed in this patient experience where there was no interaction between physicians even between physicians in the same hospital.…”

Effects of Medication Reviews Performed by a Physician on Treatment with Fracture‐Preventing and Fall‐Risk‐Increasing Drugs in Older Adults with Hip Fracture—A Randomized Controlled Study

“…The design of the intervention also increased the interchange between the hospital and the primary care physicians. Lack of such communication is often pointed out as a problem . This approach also reduced the risk of conflicting messages to the participants regarding their drug treatment because only the responsible physician discussed the drug treatment with the participant.…”

Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial

“…All participants’ perceptions of care integration will be captured in the exit questionnaire. In the absence of a formally validated instrument to measure the outcome of interest [70], the measurement tool will consist of a customized version of a questionnaire on the perception of care integration from a patient perspective [71]. Five questions, corresponding to the interaction subscale, are being used to investigate this study objective on program integration.…”