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Poor communication hampered medication adherence
Improving communication between patients and health care providers could affect cardiometabolic medication refill adherence, according to study results published in the Archives of Internal Medicine.
Using data from the Diabetes Study of Northern California survey, researchers designed a cross-sectional analysis of 9,377 patients (aged 30 to 75 years with diabetes) to assess the association between patient communication ratings and cardiometabolic medication refill adherence.
The Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) was used to measure communication. According to data, 30% of the cohort had poor cardiometabolic medication refill adherence. Furthermore, the adjusted prevalence of poor adherence increased by 0.9% (P=.01) for each 10-point decrease, researchers wrote.
Additionally, those who gave health care providers lower ratings for including patients in decision-making (P=.04), understanding patients’ problems with treatment (P=.02), and eliciting confidence and trust (P=.03) were more likely to have poor adherence compared with patients offering higher ratings, researchers wrote.
“Promoting patient centeredness is a laudable objective even without better health outcomes. Studies of patient-centered communication such as Ratanawongsa et al are an important stop on the road to patient centeredness,” Aanand D. Naik, MD, of the VA Medical Center in Houston, said in an invited commentary.
The researchers concluded that further studies are needed to determine whether improving communication skills between clinicians and patients could improve cardiometabolic medication refill adherence.
For more information:
Naik AD. Arch Intern Med. 2012; doi:10.1001/jamainternmed.2013.1229.
Ratanawongsa N. Arch Intern Med. 2012;doi:10.1001/jamainternmed.2013.1216.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Patient adherence is one of the most difficult challenges in medicine today. Poor compliance to medication and lifestyle changes results in adverse outcomes and is potentially the largest contributor to preventable health care costs. Studies have shown that adherence to therapy is influenced by many factors, but there has been increased focus in controlled trials to determine if improved patient communication can result in better outcomes. However, just as with other issues, each patient is different in regard to what type of communication is most likely to influence their behavior. That is why there are multiple approaches that should be considered for an individual patient.
Behavioral experts believe that ‘motivational interviewing’ will most likely improve patient compliance to therapy. Motivational interviewing has four general principles: express empathy; develop discrepancy, which means guiding the patient to understand the value of the therapy or change in behavior; roll with resistance, which encourages not fighting resistance but rather exploring patient alternatives to overcome perceived obstacles; and support self-efficacy, which involves embracing the patient’s autonomy even when they choose not to change. However, if behavior does not change, help them through their own creativity to develop an alternative approach to maximize adherence.
Patient communication is a skill that needs to be learned, just like echocardiography or coronary angioplasty. I would encourage cardiologists to understand the principals of motivational interviewing and invest in the skill training necessary to better improve patient adherence to therapy. It may not seem as impactful as percutaneous transluminal coronary angioplasty for ACS, but over the long term getting the patient to adhere to statin therapy and lifestyle changes will have potentially a greater effect on their long term prognosis.