This article has been cited by. 1, Investigation of variables associated with medication nonadherence in patients with hypertension in Patient and Physician Satisfaction Concerning Hypertensive Patients Voice Study? 3, Treatment Adherence in Patients with Hypertension: A Cross. Non-adherence to medication and doctor-patient relationship: Evidence from a European survey. Article in Patient Education and Counseling 83(1) · April. Primary medication adherence occurs when a patient properly fills the first Article Navigation A trusting patient–provider relationship, shared decision- making support, Eligible patients included those age ≥25 who did not pick up a filled . How's the doctor know who you are by looking at a laptop?.
Among these patients with incomplete PMA, distrust and anger regarding the hypertension diagnosis and the need for antihypertensive medications were common. Other PMA barriers included cost, misperceptions about generic medications, fear of side effects and beliefs that not more than one antihypertensive medication was needed.
Patients longed to be included more actively in discussions with their providers about the initiation of hypertension treatments and suggested approaches to shared decision making and patient-oriented materials that would make PMA more likely. Our qualitative results are consistent with these results, because they show that missed opportunities for collaborative discussions lead to incomplete PMA for antihypertensive medications.
Efforts to improve PMA should therefore involve patients in the initial prescribing decisions, offering patients opportunities to communicate their preferences [ 113233 ]. Unfortunately, training providers to enhance communication can be lengthy and resource intensive, and it is not widely available [ 34 ].
How else can a collaborative relationship be introduced and strengthened, even as most providers and patients do not receive communication skills training? A promising approach is the use of decision support tools, which provide structure to the decision-making process, breaking it down into smaller, manageable steps [ 14 ] and require no formal training to use.
Patients in our study endorsed the use of decision support tools, suggesting content such as sample dialog and a frequently asked questions list to get the much-needed information. Although patients in our study disagreed on how content should be presented, a flexible decision support tool might include multiple formats to communicate information.
Together, patients and providers can then choose the optimal format or focus on the content that is most relevant to them. Other approaches that enhance communication and foster collaborative care may also hold promise; future research should focus on identifying and testing such approaches in real-world clinical settings [ 37 ] and evaluate the extent to which decision support might be integrated[ 38 ]. To our knowledge, our study is the first to examine the knowledge, attitudes and beliefs among patients, who were identified as primary non-adherent via their retail pharmacy claims.
[Full text] Patient–doctor relationship and adherence to capecitabine in out | PPA
This novel method focused our work on patients who, by not filling a prescription, had decided not to engage with the healthcare system at a specific point in time. For example, costs were noted as a key barrier, but most patients believed that if a provider prescribed a less-expensive generic medication, the generic would be less effective than its brand name counterpart. In fact, research has shown that reducing or eliminating costs improves medication adherence only slightly [ 2 ]; our findings provide a potential explanation for these small improvements.
Other patients were concerned about incomplete disclosure of side effects or treatment options. Finally, some patients believed that their providers had made mistakes or had financial motivations, particularly when more than one antihypertensive drug was prescribed.
Decision support tool content may also act as a reminder to providers to discuss basic details they might overlook such as the name of the drug and more complex information such as side effects [ 34 ].
Patients may be prompted to ask questions they otherwise might be reticent to ask. Our study has several limitations. The participants in our focus groups opted in, and because these patients self-selected, they may have held particularly strong views that were not representative of the larger patient population with incomplete PMA.
The Cause and Effect of Patient Non-Adherence
It is likely that these patients represent those with the highest barriers to PMA. However, other studies have documented similarly poor patient—provider relationships, costs, fear of side effects and complexity of treatment as adherence barriers [ 9 ].
Focus group patients reported receiving diagnoses of hypertension both recently and during the more distant past. Although we focused on hypertension, a common problem [ 5 ], specific decision support tool content needs to be tailored to a given clinical condition.
However, we believe that our findings and the themes outlined here are relevant to other disease settings.
Finally, regardless of the communication enhancement strategy suggested—whether decision support tools or motivational interviewing, for example—some providers will not be interested in collaborative relationships with their patients. Previous studies and successful interventions to improve medication adherence have typically focused on barriers such as costs, forgetfulness and simplifying dosing regimens [ 239 ].
Our findings suggest that, while such interventions are important to sustaining medication adherence [ 2940 ], they are unlikely to fully address the problem of PMA, so alternative approaches like shared decision making with decision support tools, for example, are needed to engage patients as well as their providers.
- Non-adherence to medication and doctor-patient relationship: Evidence from a European survey.
- City Research Online
- The Role of Patient-Physician Trust in Moderating Medication Nonadherence Due to Cost Pressures
Decision support tools may present a forum to establish provider credibility and patient trust prior to and at the point of prescribing an antihypertensive medication, thus improving PMA.
Two instruments patients' satisfaction derived from the relationship with physicians and MMAS were simultaneously completed in the self-reported form. After that the questionnaires were completed, all of them were reviewed by the researchers.
Such confounding variables as physicians' gender, disease duration, and patients' age, gender, and education level were considered in the logistic analysis, and the adjusted model was also reported.
We applied simple random sampling to control the sampling bias and the trained data collectors to control the interviewer's bias. The data were analyzed in two ways: Results A total of samples were analyzed in this study. The mean age of the participants was The majority of the samples A disease history of 5 years or lower was reported by No significant OR was found in other underlying variables [Table 2].
Participants variables and medication nonadherence Click here to view The mean and standard deviation of patients' satisfaction resulting from the relationship with their doctors among the patients with appropriate and inappropriate medication adherence were, respectively, 3.
In this study, the relationship between the medication adherence and patients' satisfaction derived from their relationship with physicians was studied, using adjusted and unadjusted models for the following variables: The comparison of nonadherence to the treatment is partially difficult due to several instruments that test this nonadherence, including checking by telephone, counting pills, electronic monitoring, and self-report questionnaire.
It appears that various methods along with characteristics of the community play an important role revealing different results. Since the majority of our patients had studied up to high school or lower grades, and level of education is known as a primary factor in medication adherence, the high proportion of nonadherence in this study is noticeable.
Despite the importance of doctor-patient relationship, Maguire et al. Numerous explorations have also indicated the effect of proper doctor-patient relationship on medication adherence.
The importance of communication skills has also been highlighted in other studies. Larsen and Smith reported a decreased level of satisfaction following an increased level of face-to-face communication with the physician.
We noticed that emotional and psychiatric support by doctors and a sense of trust can noticeably affect patients' satisfaction, leading to more effective treatment outcomes. It appears that empathy followed by an effective relationship with doctors plays an important role in coping with and accepting the illness. Finally, empathy and this relationship could be considered as major factors in medication adherence among hypertensive patients. These different responses could lead to different levels of satisfaction.
A self-report questionnaire was employed whose accuracy to assess adherence to medication has been doubted by few studies.
The Cause and Effect of Patient Non-Adherence
In addition, a comprehensive figure was not provided for all main factors affecting medication adherence among patients with hypertension. Conclusion The beneficial outcome of adherence to treatment is necessarily required by knowing how to establish an appropriate relationship between patients and their physicians and its determinant variables.
We found a significant relationship between patients' satisfaction and empathy caused by their relationship with physicians and medication adherence among hypertensive patients. Yet, no one should expect that patients' satisfaction is achieved in a short time. Acknowledgments We would like to express our special thanks to the Deputy of Research of Isfahan University of Medical Sciences for its financial support number: