Communication key in helping patients adhere to medicine

Jan 14 2013

By Caroline Price, Senior medwireNews Reporter

Patients are less likely to take their medications properly if they feel their family doctor or other primary care clinician is failing to communicate with them adequately, suggests a US study published in the Archives of Internal Medicine.

In particular, problems appear to arise with a lack of trust in the clinician, or a feeling that the clinician does not fully take on board the problems patients are having with treatment.

The study was conducted in a large primary care population of 9377 patients with diabetes. Researchers found those reporting low ratings of patient-centered communication and trust with their doctors had 4-6% worse cardiometabolic drug nonadherence rates than patients reporting high ratings, after adjusting for clinical and sociodemographic characteristics.

The communications ratings were based on standard questionnaires, one on healthcare provider communication, with questions such as "does your clinician explain things (directly or through an interpreter) in a way you can understand?" and another two that included items related to shared decision making, problem solving, and trust within patient-clinician relationships.

Patient answer options of "never"/"sometimes" were considered poor ratings and "usually"/"always" were considered high ratings, while poor or 'non'adherence was defined by having no medication supply 20% or more of the time.

Further analysis indicated that the relative risk for nonadherence was 7-16% higher among patients reporting poor communication; the risk was statistically higher with poor ratings for trust and for understanding of problems with treatment, but not for patient involvement in decisions.

Study authors Neda Ratanawongsa (University of California, San Francisco) and team note that poor communication was somewhat more strongly associated with oral hypoglycemic medication nonadherence, compared with lipid-lowering and antihypertensive medications.

The complexity, adverse effects, or perceived benefits of these drugs may mean patient adherence to them is particularly "sensitive" to the influence of communication between provider and patient, they say.

"Future studies should investigate whether targeting communication interventions for clinicians or health systems with poorer patient communication ratings may improve medication refill adherence and ultimately clinical outcomes," they conclude.

In a related editorial, Aanand Naik (Baylor College of Medicine, Texas) cautions that patient-centeredness is "much more than what clinicians do to achieve quality", requiring also greater patient responsibility, in particular to avoid overuse of healthcare.

"Clinicians should help patients assume responsibility for their decisions as much as they inform and motivate them," Naik writes.

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