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Communication improves BP medication adherence in low-income patients
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Low-income individuals with high BP were less likely to take their medication when their physician did not ask them about social issues or did not engage in collaborative communication, according to recent findings.
“Despite advances in treatments for [CV] risk factors such as hypertension, poorly controlled BP continues to be a significant public health problem in the United States,” Antoinette Schoenthaler, EdD, associate professor in the departments of population health
and medicine at NYU School of Medicine, and colleagues wrote. “Medication nonadherence is a pervasive problem contributing to inadequate BP control. The patient-provider relationship offers an ideal opportunity to address patient nonadherence, as providers’ communication skills contribute to as much as 50% of the quality of care patients receive.”
Schoenthaler and colleagues audiotaped 92 patient-physician interactions during a 3-month period from three centers that serve multiethnic, low-income populations in New York. Medication adherence was evaluated through an electronic monitoring device that records when the pill bottle is opened.
The mean age of patients was 60 years, 61% were black, 58% were women, most had been seeing the same provider for at least 1 year and 58% had poor adherence to prescribed antihypertensive medications. Of the health care providers, 56% were white, 67% were women and they had been in practice for an average of 5.8 years.
When conversation was less patient-centered, the patients were less likely to adhere to their medication (OR = 3.08; 95% CI, 1.04-9.12). Patients were about six times more likely to have poor adherence when physicians did not talk about patients’ social-demographic circumstances such as employment, living situation and relationship with partner (OR = 6.03; 95% CI, 2.15-17) or when they did not discuss antihypertensive medication (OR = 6.48; 95% CI, 1.83-23), the researchers found.
The association between not talking about social-demographic circumstances and poor medication adherence was stronger for black patients (OR = 8.01; 95% CI, 2.8-22.9), Schoenthaler and colleagues wrote.
“Regarding recommendations for next steps in research and practice, we believe that the evidence base for linking communication and adherence is strong enough that the focus should begin to be on implementation,” Edward Havranek, MD, of Denver Health, and Stacie Daugherty, MD, of the University of Colorado School of Medicine, wrote in an accompanying editorial. “The paper by Schoenthaler et al suggests that simple recommendations, such as exploring patients’ psychosocial situations, may improve adherence and diminish racial disparities. It will be important to understand the barriers to implementing simple recommendations such as this one, and to devise means to work past the barriers.” – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures. Daughtery and Havranek report receiving grants from the American Heart Association and the NHLBI.
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