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Drug Adherence Linked to Communication

Diabetic patients treated by healthcare professionals who had poor communication skills were less likely to refill their cardiometabolic medications by more than 30% than those whose doctors were good communicators….

According to Neda Ratanawongsa, MD, of the University of California San Francisco, and colleagues, among a cohort of more than 9,000 patients with diabetes, a 10-point decrease in scores for healthcare provider communication quality increased rates of poor adherence by a significant 0.9% (95% CI 0.2% to 1.7%, P=0.01).
Patients of healthcare professionals with low ratings on involving patients in decisions, understanding patient problems with treatment, and eliciting trust and confidence were significantly more likely to have poor adherence than those with higher ratings.
The study analyzed associations between patient perception of healthcare provider communication with adherence to refilling cardiometabolic medications among a cross section of 9,377 diabetic patients, ages 30 to 75, who were taking one or more oral hypoglycemic, lipid-lowering, or antihypertensive medications within 12 months of the survey.
The researchers used a subset of questions from the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) to evaluate provider communication skills. Participants were asked to rate providers on overall communication quality, shared decision-making with patients, understanding patient problems, and trust.
Outcomes for patient refill adherence were gathered through pharmacy data based upon the continuous medication gap, which "sums the proportion of days without sufficient medication supply" across refill intervals over a period of time. Poor adherence was defined as an absence of medication supply for greater than 20% of the time period examined.
Medication gaps were calculated for hypoglycemic medications, lipid-lowering medications, and antihypertensives. Differences in rates of adherence between patients with physicians who scored lower or higher in communication abilities were adjusted for age, sex, race/ethnicity, education, English language proficiency, functional health literacy, income, prescription and outpatient copayment requirements, depression, Charlson comorbidity index, external locus of control, and conscientiousness.
Participants had a mean age of 59.5, were about equally split by gender (52% female), received a mean of 5.2 cardiometabolic medications, and had seen their primary care provider for a mean of 6.2 years. In terms of racial/ethnic groups, the largest percentage — 27% — were white, followed by African Americans (19%), Latinos (16%), Asians (12%), and Filipinos (11%).
A total of 30% of respondents had poor adherence to their cardiometabolic medication regimens, with poor adherence seen for 20% of patients taking antihypertensive drugs, 21% taking lipid-lowering drugs, and 25% of patients on oral hypoglycemic drugs.
Compared with providers who received high scores, low scores on receiving patient input in decision-making were associated with an adjusted absolute decrease of 4% in adherence (P=0.04), low scores on understanding patient problems with treatment were associated with an adjusted absolute decrease of 5% in adherence (P=0.02), and low scores on trust and confidence were associated with an adjusted absolute decrease of 6% in adherence (P=0.03).
There was no association seen between adherence to refills of blood pressure medications and provider communication scores.
Practice Pearls:
  • Adherence to blood pressure medications seemed to be unaffected by patient perception of provider communication skills.
  • This cross-sectional study of 9,377 patients in the Kaiser Permanente healthcare system demonstrated a small but significant worsening of adherence to cardiometabolic medications among patients who reported that their physicians were poor communicators.