How do providers assess antihypertensive medication adherence in medical encounters? Authors
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.
Hajjar I, Kotchen TA
. Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.
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.
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.
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.
Jamerson K, DeQuattro V
. The impact of ethnicity on response to antihypertensive therapy. Am J Med. 1996;101:22S-32S.
. The persistent problem of poor blood pressure control. Arch Intern Med. 1987;147:1393–6.
NHLBI Working Group. Management of patient compliance in the treatment of hypertension: report of the NHLBI working group. Hypertension. 1982;4:415–23.
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.
. Improving compliance and increasing control of hypertension: needs of special hypertensive populations. Am Heart J. 1991;121(suppl):664.
Gallup G, Cotugno H
. Preferences and practices of Americans and their physicians in antihypertensive therapy. Am J Med. 1986;81:20–4.
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.
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.
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.
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.
Kjellgren K, Svensson S, Ahlner J, Saljo R
. Antihypertensive medication in clinical encounters. Int J Cardiol. 1998;64:161–9.
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.
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.
Morris G, Chenail R. The Talk of the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse. Hillsdale, NJ: Lawrence Erlbaum Associates; 1995.
Schiffrin D. Approaches to Discourse. Cambridge, MA: Blackwell Publishers; 1994.
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.
Baker D, Parker R, Williams M, et al.
The health care experience of patients with low literacy. Arch Fam Med. 1996;5:329–34.
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.
Mead M, Bower P
. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.
Kjellgren K, Ahlenr J, Saljo R
. Taking antihypertensive medication — controlling or co-operating with patients. Int J Cardiol. 1995;47:257–68.
Ong L, De Haes J, Hoos A, Lammes F
. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903–18.
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.
Frankel R, T S. Getting the most out of the clinical encounter; The four habits model. Permanente J. 1999;3:1–8.
Lee R, Garvin T
. Moving from information transfer to information exchange in health and health care. Soc Sci Med. 2003;56:449–64.
. The meaning of medications: another look at compliance. Soc Sci Med. 1985;20:29–37.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy of Sciences; 2001. Copyright information
© Society of General Internal Medicine 2006