From 14 patients approached, 11 participants were interviewed, 54% of whom were male, with a mean age of 77 years. Interviews ranged from 6.21 to 20.27 minutes (Table 1). Of the 11 participants, six (54.5%) were categorised as accepting, three (27.3%) were ambivalent, and two (18.2%) had insufficient data to calculate based on baseline BMQ. From the interview data, three main themes emerged: necessity and concern conflict, knowledge of medications, and relationships with healthcare providers.
Necessity and concern conflict
The majority of participants reported that they accepted medications that were necessary to ‘keep you ticking over’ (P655, female, 76 years) and ‘keeping the engine running’ (P161, male, 80 years). Some participants were however concerned about long-term medication use and potential adverse side effects, particularly for medications prescribed for prevention of future problems:
‘Well maybe, you know you read the leaflets, but I mean you read them and there is everything on it, you know, there could be side effects, and they just like have them a hundred and one, and you say to yourself, Oh my God. If you get them [medication] for blood pressure, they say they could cause your blood pressure to go up, they could cause heart attacks, you know all this. So you don’t know whether you are doing right or wrong having a particular medication, I don’t know.’
(P74, female, 72 years)
‘Well, there is one worry that you do have at the back of your mind, that when, I’m so long on the tablets, you know what I mean, and there might be something happening and I don’t know about it because I feel OK, but you don’t know.’
(P125, male, 75 years)
Medications prescribed for symptomatic relief were viewed as beneficial and more readily accepted, often despite potential side effects:
‘I should say, I didn’t take them [medication] one particular morning and didn’t take the tablet that night, but by God, I knew all about it the next day. I didn’t realise I really relied on those tablets as much as I am. And I’d say if I didn’t have those I don’t know where I would be.’
(P1315, male, 81 years)
‘COPD [chronic obstructive pulmonary disease] is a nuisance but you just have to take the old inhalers and that. I don’t like being on steroids. Recently, as you know I’ve osteoarthritis, and I was in recently getting injections in my back, for the pain in my back you know, and you know the little thing they put in your arm, to knock you out, that thing, it tore the skin, and just the eh, anaesthetist who was putting, he said “You must be on steroids”, it makes my skin very thin. So that’s the bad effect of the steroid, but then, if I need them to breath! Catch 22, isn’t it.’
(P655, female, 76 years)
Relationships with healthcare providers
The majority of participants described positive relationships with their GPs, citing satisfactory aspects of consultation style, including approachability, being listened to, and feeling comfortable:
‘I would say, I find that practice very approachable, both Dr X and Dr Y, they’re both, you can just speak to them you know, like a friend. Anything I’d have to say I could talk freely with them, you know, there is no kinda, doctor–patient where you are nearly afraid as we were years ago, there’s nothing like that, I feel very comfortable with them I suppose is the word.’
(P655, female, 76 years)
‘I always find it rewarding because he [GP] is a very knowledgeable man and he is very dedicated.’
(P1347, female, 84 years)
GPs who were perceived as supportive and engaged fostered a sense of trust, and participants were confident they would make the right treatment decisions, even where reviewing or stopping medications was concerned:
‘I trust Dr X, you know with anything she does, you know she only gives me something for a reason, she doesn’t just give me it for the sake of it, “Oh I’ll have to get rid of her” or something like that, no. She is very thorough and very conscientious.’
(P2338, female, 72 years)
‘Well I mean the doctor said it to me you know, “Oh I don’t like you taking Difene”, I say why, “Because it’s very hard on the stomach” you know, and I think it’s the kidneys or the liver or something, you know, I accept what they tell me. Well that’s what we go to the doctor for isn’t it — to be told what’s good for your body.’
(P655, female, 76 years)
‘I think that is what you would be looking for [review of medication], because nobody wants to take more medications than they need to.’
(P1345, male, 81 years)
Familiarity was a key element, with established relationships and positive past experiences increasing patient confidence:
‘I go with him [GP]. He’s been very good over the years and I’m always led by him. What he says I’ll take his word for it as right.’
(P125, male, 75 years)
‘I have a very good GP, Dr Y and he has a few assistants there, and eh, they’re all very attentive there I must say, all very very good and he’s available at all times, you know, all you do is lift the phone and you get an appointment.’
(P639, male, 78 years)
Some participants did express dissatisfaction about aspects of how medications were prescribed, in terms of information provided, particularly where hospital prescribing was concerned:
‘You see people of my age going in to the pharmacist and coming away with a big parcel of stuff, now I wouldn’t know, their general, whether they need all them things or not, but I would get the impression that they’re not keeping, you know, there is probably no need for a lot of the stuff that they’re taking you know.’
(P1616, male, 75 years)
‘I’m saying specifically if you go, you go to the hospital rather than your doctor, with something that needs to be done up in the hospital, they treat you, and they say well go on this, you know, do whatever, but they never tell you how long, and you stay on the thing then for, indefinitely like.’
(P74, female, 72 years)
Three interviewees spontaneously discussed the role of pharmacists in prescribing, reporting positive interactions, particularly citing helpful innovations the pharmacists provided such as pill boxes:
‘And I now I have got these things, they do it all in the chemist with these packs, it’s plastic like a tray, and it’s brilliant, and I’m quite happy with that.’
(P2338, female, 72 years)
