Reasons for not following the recommendations | Quotes |
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Alternatives and recommendations had already been tested and the GP and/or the patient felt that this was not the optimal way of treatment. | It's a long way making that decision and once it’s made and then it is an important drug. I don’t care if there is a contraindication, he’ll get it nevertheless. (GP 19) |
Why in this patient I won’t follow the recommendations is that it has already been tried out in the past. (GP 3) | |
The GP regarded the medication as being necessary. | Out of the multimorbidity of the people, it is inevitable that one gives them [the drug]. (GP 6) |
The GP and/or the patient had other priorities compared to the PRIMA-eDS tool. | Then the patient decides for me. From a certain age on it is about the quality of life. (GP 10) |
Concerning diclofenac for the older patients it simply is like that, he just doesn’t want [to discontinue the drug] and says, “you can’t take this away from me. [I am] free of pain for the first time in 7 years. I need that.” (GP 10) | |
The GP feared that changing medication could get complex. | In case of a patient for whom this medication works so well, in inverted commas, over such a long period of time I won’t change anything. This would just rock the boat. (GP 3) |
The GP had been prescribing the medication for years and lacked motivation to reconsider. | And that is simply a drug that the patient is using for 30 years now and under which she is well managed concerning her blood levels. [And] as mentioned leading a life with very little hardship with over 90 years. I would not touch it, that is [a case of] ‘never change a winning team’, therefore these are things I wouldn’t change. (GP 12) |
The GP did not want to diverge too far from a standard of therapy (guidelines). | So you have to ultimately stick to the general guidelines, because if you go there now radically, then you contravened the guidelines of the professional societies. It’s difficult. (GP 9) |
The GP found the recommendation to be new and not comprehensible. | I’ve never heard that before, it somehow was completely new to me and so I ignored it. (GP 16) |
The GP considered the recommendation as not applicable to the individual patient. | Where I say that the patient is biologically younger. (GP 1) |
The GP found that the patient was a barrier to discontinue medications. | The patient won’t cooperate. If there wasn’t the patient, everything would be easier. (GP 15) |
The prescription was made by another medical specialist and the GP did not want/ did not dare to change it. | Who is responsible for which prescription. The things I do not prescribe, the four medications I do not prescribe, the four psychotropic drugs, I can’t change that. (GP 7) |
It seems that due to the infrastructure medication changes resulting from the CMR could have been delayed or even forgotten. | This actually is a relatively long process, as I don’t have internet access here. […] I print it [the CMR] and make notes. […] Then I wait until the patient comes again. But I have [a study patient] who doesn’t come very often and then it's difficult. (GP 2) |