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

Farup, Per Grønaas; Blix, Ivar; Førre, Sigurd; Johnsen, Gjermund; Lange, Ove Juel; Johannessen, Rune; Petersen, Hermod
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/300603
Date
2011
Metadata
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  • Institutt for klinisk og molekylær medisin [2006]
  • Institutt for samfunnsmedisin og sykepleie [1712]
  • Publikasjoner fra CRIStin - NTNU [19778]
Original version
BMC Health Services Research 2011, 11   10.1186/1472-6963-11-111
Abstract
Background: Optimal 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.

Methods: Twelve 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.

Results: Failing 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.

Conclusions: Treatment 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.
Publisher
BioMed Central
Journal
BMC Health Services Research

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