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

摘要

Background: Optimal treatment gives complete relief of symptoms of many disorders. But even if suchtreatment is available, some patients have persisting complaints. One disorder, from which the patientsshould achieve complete relief of symptoms with medical or surgical treatment, is gastroesophagealreflux disease (GERD). Despite the fact that such treatment is cheap, safe and easily available; somepatients have persistent complaints after contact with the health services. This study evaluates the causesof treatment failure.Methods: Twelve patients with GERD and persistent complaints had a semi-structured interview which focused onthe 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 questionnairefor each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to thepatient, 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 byfailure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and10% 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 thepatients.Conclusions: Treatment failure is a complex problem. Inadequate interaction in the health services seems to beimportant. Improved communication between parts of the health services and with the patients are areas ofimprovement.