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Effective patient–physician communication produces better outcomes in atherosclerotic CVD
Patients with atherosclerotic CVD who had good communication with their physician had fewer visits to the ED and adhered to their provider’s recommendations of statins and aspirin, according to a presentation at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions.
Researchers reviewed patient–provider communication among 6,810 participants aged 18 years or older with atherosclerotic CVD, a representative sample of 18.3 million patients in the United States with atherosclerotic CVD in the MEPS cohort. Participants answered four questions, which rated the quality of patient–provider communication on a four-point scale covering the provider’s respect for the patient, listening to the patient, explanations to the patient and time spent with the patient. A weighted composite score was then developed.
Outcomes included patient-reported physical and mental health status per the Short Form-12 questionnaire, statin and aspirin use, ED visits and hospital stays, and total annual and out-of-pocket health care expenditures.
According to the final abstract, participants who reported ineffective patient–provider communication were twice as likely to report poor outcomes compared with those who rated their patient–provider communication as effective (OR = 2.28; 95% CI, 1.86-2.79). Compared with those with effective communication, those with ineffective communication were less likely to report statin use (OR = 1.52; 95% CI, 1.26-1.83) and aspirin use (OR = 1.36; 95% CI, 1.04-1.79).
Health care resource utilization was higher in those with ineffective communication, who were likely to require two or more ED visits (OR = 1.41; 95% CI, 1.09-1.81) and two or more hospital stays (OR = 1.36; 95% CI, 1.04-1.79) during the study period vs. those with effective communication. Annual and out-of-pocket health care expenditures were an estimated $1,243 higher for participants with ineffective communication with their physicians vs. those with effective communication.
“One cannot say for sure how communication exactly influences health outcomes,” Victor M. Okunrintemi, MD, MPH, a researcher at Baptist Health South Florida in Miami, said in a press release. “However, optimal communication between patients and their health care providers may yield better understanding of the medical condition, build trust and confidence, motivate patients and promote adherence to medication, which could improve patients’ health status while reducing the need for unnecessary health resource utilization, which can lower health care expenditures.” – by Darlene Dobkowski
Reference:
Okunrintemi VM, et al. Presentation 2. Presented at: American Heart Association Quality of Care and Outcomes Research Scientific Sessions; April 2-3, 2017; Arlington, Va.
Disclosure: The researchers report no relevant financial disclosures.
Editor’s Note: This article was updated on April 6, 2017 to correct the size of the sample population. The Editors regret the error.
Perspective
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These findings are in line with what we would expect; that the better we communicate why people need to take medications or when medications are indicated, the more likely they are to be compliant with that medical therapy. And, potentially, the more we listen to the patient’s experience with living with atherosclerotic CVD, we may be able to prevent unnecessary ED visits or hospitalizations.
We’re giving a lot of information during 20-minute office visits, and it can be a lot for people to digest in one sitting — especially when giving a new diagnosis — so they may feel confused or unsure of instructions by the time they leave. It can be helpful to have the clinic nurse meet with the patient after the physician encounter to review the After Visit Summary with the patient. This is another opportunity to again review medication changes and instructions for additional testing and follow-up. The patient can ask more questions and have pertinent information repeated back to them.
Setting an agenda for an office visit is also wise. To prevent those “surprise” questions just as you are reaching for the door handle, it may be beneficial to say, “Let’s pick the top two or three things that are most important to you today, and we’ll be sure to address those. If there are other concerns or questions we can’t get to today, then we’ll schedule you for another follow-up visit or we can discuss further through our patient portal.
As a preventative cardiologist, I would like to know if there is any correlation between effective patient-provider communication and influence on healthy lifestyle habits (ie, BP, diabetes and cholesterol control, as well as weight and smoking habits).
Does communicating health risks and developing a patient-centered secondary prevention plan make patients more likely to quit smoking, exercise more and eat better? Prior studies have shown short-term benefit, but sustaining healthy lifestyle habits has been elusive.
I have also found that direct-to-consumer marketing of medications or medication side-effects has created significant challenges in my patient encounters. Almost every time I try to recommend statin therapy to a patient, I have to spend 10 to 15 minutes going over the misinformation they have heard on TV about adverse events. The same thing is true for anticoagulants for atrial fibrillation. Many patients are reluctant to take a medication they have seen associated with lawsuits on TV, which I would imagine must have some impact on medication compliance.
Lastly, it is important to note that doctors are people too, each of us with our own personalities and life experiences, so every patient-provider relationship is not always a good fit. Sometimes when you’re not seeing eye-to-eye with a patient, even if you’ve tried different approaches, it may be best to say, “I can see that we are struggling in our communication with each other. Would you like to try seeing my colleague Dr. X for a second opinion?”