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Length, nature of patient-provider relationship may improve medication adherence
Patients who had an established relationship with their medical provider were as likely to take their medication as those patients who actively engaged in shared decision making, according to findings recently published in the Journal of the American Board of Family Medicine.
“Previous research has examined the benefits of engaging in [shared decision making] with patients but few studies have looked at the reasons why shared decision making may have a positive impact. In this study, we examined longitudinal continuity (i.e., number of years with the provider) as one potential explanation for how shared decision making affects health outcomes such as medication adherence in hypertensive patients,” Antoinette Schoenthaler, EdD, FAACH, associate professor at the Center for Healthful Behavior Change at the New York University School of Medicine, told Healio Family Medicine.
Researchers used 27 primary care providers and 75 patients with hypertension for the analysis. Most patients were going to their provider for more than 1 year, and most providers were practicing at the same location for 6 years.
Researchers found shared decision making became less important as time with the same provider increased (P = .04). They also found patients who favored shared and active decision-making styles (P = .02) were more likely to show better adherence to their medication vs. those who favored a passive style (P = .004).
“We often talk about shared decision making being the patient-centered strategy that in theory would lead to better outcomes over more passive patient behaviors,” Schoenthaler told Healio Family Medicine.
“This research suggests that there are other qualities of a patient-provider relationship that emerge over time that must be taken into account, such as development of a therapeutic alliance, increased familiarity with patients’ needs and preferences, increased trust and a sense of partnership that allows patients to be comfortable participating in the decision making process, at their preferred level of involvement, and for providers to offer the appropriate level of decisional support to patients,” she said.
Schoenthaler added that she understood clinicians’ “frustration” with the abundance of studies that claim to have found a way to improve medication adherence but added both patient and clinician benefit from her approach.
“Our research underscores the importance of developing a relationship where patients feel free to express their needs and preferences in the manner that they feel most comfortable. When physicians work with patients rather than against them, the patient will be much more likely to adhere to their medications. In most cases, this doesn’t even take more time. It is just switching from a more directive approach with patients to bringing the patient into the conversation,” she said.
“This also saves time in the long run because physicians won’t have to be continually guessing whether the patient took their medications correctly. Rather, the patient will be more open and honest about discussing their behaviors. Our research also underscores the importance of a continuous relationship that allows these conversations to happen over time rather than having to do it all in one visit,” Schoenthaler added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.