Given the significant impact medication adherence has on healthcare quality and costs, providers, payers, and researchers have tried to figure out what makes one patient adhere strictly to a potentially life-saving medication regimen and another give up after a couple of months. The difference, according to a study in the Archives of Internal Medicine, may be the physician.
Researchers at McGill University in Montreal looked at adherence to prescribed antihypertensive medication, and found that a physician's medical management and communication skills influenced whether a patient stuck with the regimen.
Within six months after starting treatment, more than 22% of all patients had discontinued the medication, many of them within the first 60 days. But physicians with higher-than-average clinical decision-making ability reduced noncompliance by 23%, and for doctors with strong communication skills noncompliance was 12% lower. Researchers measured both skills using scores from Canada's licensing examinations.
The findings are significant because they point to possible steps providers and healthcare organizations could take to improve medication adherence by educating and training physicians. "Training programs could improve the ability of physicians to manage chronic conditions by ensuring that these aspects of management are systematically incorporated into undergraduate and postgraduate medical training," the authors wrote.
Evaluation tools to support clinical decision making and medication monitoring in the practice environment may be even more fruitful, they said.
The long-term impact of such a change could be large. Between one third and one half of all patients don't take medication as instructed, and some of them end up returning to the hospital with more severe conditions as a result. Measured in otherwise avoidable spending, that costs the U.S. healthcare system as much as $290 billion a year, according to an estimate from the New England Healthcare Institute.
Medication adherence has proved difficult to improve, and providers and payers have tried everything from case management to paying patients to take their medications. It's a big challenge because there are multiple phases to adherence, said Edmund Pezalla, MD, MPH, national medical director with Aetna, who is testing several pilot projects for improving compliance.
Many people have problems during the first stage, when they begin taking the medicine, he said. "This is a phase where people just don't get started taking their medication. They may not understand why they're taking it or may not be convinced it will work. They may also have safety concerns."
In fact, the McGill University study found that physician communication skills were most important early on in a treatment cycle. The most significant factor in determining compliance was a treatment change -- a modification in drug or dosage to account for an adverse reaction -- before the end of the first prescription, and doctors with stronger clinical and management skills were more likely to make such a change.
The more communicative and knowledge physicians may have had better results "either because they followed up their patients more effectively, or their patients were more motivated to report problems," the researchers wrote.