Primary care physicians feel responsible for assessing patients’ medication adherence, but rarely ask older patients about it directly
Physicians recognize a responsibility to assess whether their patients are taking medications as prescribed, but in actual patient encounters, rarely ask patients whether they are complying with their medication regimens, according to a new study. Nonadherence to taking medications as prescribed affects up to 40 percent of older adults in the United States and is associated with poor patient outcomes (including increased hospitalizations and mortality) at a cost of $290 billion/year.
The researchers analyzed focus groups with 22 physicians from multispecialty group practices in New Jersey, Washington State, and the District of Columbia. They also did content analysis for visits between 100 elderly patients and 28 primary care physicians. The focus groups revealed that the physicians felt they had a responsibility to discuss medication adherence with patients, mainly by asking patients general questions about their medication. If the physicians became aware of patients’ nonadherence, regardless of the source of the information, the physicians felt the need to address it. Few physicians mentioned using observational strategies to determine patient adherence to medication, and most physicians felt more comfortable talking about nonadherence face-to-face. However, their lack of intrusive questions about medication taking during office visits may reflect lack of physician recognition of the questions needed to fully assess adherence, note the researchers.
Based on recorded office visits, they identified medication nonadherence in 39 instances during 32 of 100 visits. However, in half (20) of these cases, comments volunteered by the patient led to identifying nonadherence, not physician questioning. In all cases with nonadherence, the physicians tried to educate the patient about the importance of taking the drug as prescribed, or adjusted the medication for patients who were not adhering because of unpleasant side-effects. The study was funded in part by the Agency for Healthcare Research and Quality (HS16391).
More details are in "Provider views about responsibility for medication adherence and content of physician–older patient discussions," by Derjung M. Tarn, M.D., Ph.D., Thomas J. Mattimore, M.D., Douglas S. Bell, M.D., Ph.D., and others in the June 2012 Journal of the American Geriatrics Society 60(6), pp. 1019-1026.