Skip to main content

Advertisement

SpringerLink
Log in

How do providers assess antihypertensive medication adherence in medical encounters?

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. Providers’ communication with patients about their medication-taking behavior may be central to improving adherence.

OBJECTIVE: The goal of this study was to characterize the ways in which providers ask patients about medication taking.

DESIGN: Clinical encounters between primary care providers and hypertensive patients were audiotaped at 3 Department of Veterans’ Affairs medical centers.

PARTICIPANTS: Primary care providers (n=9) and African-American and Caucasian patients (n=38) who were diagnosed with hypertension (HTN).

APPROACH: Transcribed audiotapes of clinical encounters were coded by 2 investigators using qualitative analysis based on sociolinguistic techniques to identify ways of asking about medication taking. Electronic medical records were reviewed after the visit to determine the BP measurement for the day of the taped encounter.

RESULTS: Four different aspects of asking about medication were identified: structure, temporality, style and content. Open-ended questions generated the most discussion, while closed-ended declarative statements led to the least discussion. Collaborative style and use of lay language were also seen to facilitate discussions. In 39% of encounters, providers did not ask about medication taking. Among patients with uncontrolled HTN, providers did not ask about medications 33% of the time.

CONCLUSION: Providers often do not ask about medication-taking behavior, and may not use the most effective communication strategies when they do. Focusing on the ways in which providers ask about patients’ adherence to medications may improve BP control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.

    Article  Google Scholar 

  2. iaJoint National Committee, Chobanian A, Bakris G, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  Google Scholar 

  3. Amery A, Birkenhager W, Brixko P, et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet. 1985;1:1349–54.

    Article  CAS  Google Scholar 

  4. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  5. Jamerson K, DeQuattro V. The impact of ethnicity on response to antihypertensive therapy. Am J Med. 1996;101:22S-32S.

    Article  CAS  Google Scholar 

  6. Winickoff R. The persistent problem of poor blood pressure control. Arch Intern Med. 1987;147:1393–6.

    Article  CAS  Google Scholar 

  7. NHLBI Working Group. Management of patient compliance in the treatment of hypertension: report of the NHLBI working group. Hypertension. 1982;4:415–23.

    Article  Google Scholar 

  8. Sackett DL, Snow JC. The magnitude of compliance and noncompliance. In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. Baltimore: Johns Hopkins University Press; 1979:11–22.

    Google Scholar 

  9. Clark LT. Improving compliance and increasing control of hypertension: needs of special hypertensive populations. Am Heart J. 1991;121(suppl):664.

    Article  CAS  Google Scholar 

  10. Gallup G, Cotugno H. Preferences and practices of Americans and their physicians in antihypertensive therapy. Am J Med. 1986;81:20–4.

    Article  Google Scholar 

  11. Horne R, Clatworthy J, Polmear A, Weinman J. Do hypertensive patients’ beliefs about their illness and treatment influence medication adherence and quality of life? J Hum Hypertension. 2001;15(suppl 1):S65-S68.

    Article  Google Scholar 

  12. Theunissen N, De RIdder D, Bensing J, Rutten G. Manipulation of patient-provider interaction: discussing illness representations or action plans concerning adherence. Patient Educ Couns. 2003;51:247–58.

    Article  Google Scholar 

  13. Ogedegbe G, Harrison M, Robbins L, Mancuso C, Allegrant J. Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethnicity Disease. 2004;14:3–12.

    Google Scholar 

  14. Stevenson F, Barry C, Britten N, Barber N, Bradley C. Doctor-patient communication about drugs: the evidence for shared decision making. Soc Sci Med. 2000;50:829–40.

    Article  CAS  Google Scholar 

  15. Kjellgren K, Svensson S, Ahlner J, Saljo R. Antihypertensive medication in clinical encounters. Int J Cardiol. 1998;64:161–9.

    Article  CAS  Google Scholar 

  16. Ockene J, Kristeller J, Goldberg R. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial. J Gen Intern Med. 1991;6:1–8.

    Article  CAS  Google Scholar 

  17. Steele D, Jackson T, Gutmann M. Have you been taking your pills? The Adherence-monitoring sequence in the medical interview. J Fam Pract. 1990;30:294–9.

    CAS  Google Scholar 

  18. Morris G, Chenail R. The Talk of the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse. Hillsdale, NJ: Lawrence Erlbaum Associates; 1995.

    Google Scholar 

  19. Schiffrin D. Approaches to Discourse. Cambridge, MA: Blackwell Publishers; 1994.

    Google Scholar 

  20. Williams M, Baker D, Parker R, Nurss J. Relationship of functional health literacy to patients’ knowledge of their chronic disease: a study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–72.

    Article  CAS  Google Scholar 

  21. Baker D, Parker R, Williams M, et al. The health care experience of patients with low literacy. Arch Fam Med. 1996;5:329–34.

    Article  CAS  Google Scholar 

  22. Kalichman S, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999;14:267–73.

    Article  CAS  Google Scholar 

  23. Mead M, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.

    Article  CAS  Google Scholar 

  24. Kjellgren K, Ahlenr J, Saljo R. Taking antihypertensive medication — controlling or co-operating with patients. Int J Cardiol. 1995;47:257–68.

    Article  CAS  Google Scholar 

  25. Ong L, De Haes J, Hoos A, Lammes F. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903–18.

    Article  CAS  Google Scholar 

  26. Braddock C, Edwards K, Hasenberg N, Laidley T, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313–20.

    Article  Google Scholar 

  27. Frankel R, T S. Getting the most out of the clinical encounter; The four habits model. Permanente J. 1999;3:1–8.

    Google Scholar 

  28. Lee R, Garvin T. Moving from information transfer to information exchange in health and health care. Soc Sci Med. 2003;56:449–64.

    Article  Google Scholar 

  29. Conrad P. The meaning of medications: another look at compliance. Soc Sci Med. 1985;20:29–37.

    Article  CAS  Google Scholar 

  30. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy of Sciences; 2001.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Boston University School of Public Health, Boston, MA, USA

    Barbara G. Bokhour PhD, Dan R. Berlowitz MD, MPH & Nancy R. Kressin PhD

  2. Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, PA, USA

    Judith A. Long MD

  3. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Judith A. Long MD

  4. Leonard David Institute of Health Economics, Philadelphia, PA, USA

    Judith A. Long MD

  5. Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Hospital (152), 200 Springs Road, 01730, Bedford, MA

    Barbara G. Bokhour PhD, Dan R. Berlowitz MD, MPH & Nancy R. Kressin PhD

Authors
  1. Barbara G. Bokhour PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dan R. Berlowitz MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Judith A. Long MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy R. Kressin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara G. Bokhour PhD.

Additional information

The authors have no conflicts of interest to report.

This study was supported by the Department of Veterans Affairs, Health Services Research and Development grant # TRH 01-038. Dr. Kressin is supported by Department of Veterans Affairs, Health Services Research and Development, RCS # 02-066-1. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bokhour, B.G., Berlowitz, D.R., Long, J.A. et al. How do providers assess antihypertensive medication adherence in medical encounters?. J Gen Intern Med 21, 577–583 (2006). https://doi.org/10.1111/j.1525-1497.2006.00397.x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00397.x

Key words

Search

Navigation