How do providers assess antihypertensive medication adherence in medical encounters?
Received: 10 March 2005 Revised: 27 May 2005 Accepted: 14 December 2005 DOI:
Cite this article as: Bokhour, B.G., Berlowitz, D.R., Long, J.A. et al. J Gen Intern Med (2006) 21: 577. doi:10.1111/j.1525-1497.2006.00397.x Abstract 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. BACKGROUND: The goal of this study was to characterize the ways in which providers ask patients about medication taking. OBJECTIVE: Clinical encounters between primary care providers and hypertensive patients were audiotaped at 3 Department of Veterans’ Affairs medical centers. DESIGN: Primary care providers ( PARTICIPANTS: n=9) and African-American and Caucasian patients ( n=38) who were diagnosed with hypertension (HTN). 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. APPROACH: 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. RESULTS: 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. CONCLUSION: Key words hypertension medication adherence provider-patient communication
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.
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