Prescribing Providers Estimate Patients’ Adherence to Hypertension and Type 2 Diabetes Medications from Patients’ Medication-Taking Routines: an Observational Study

  • L. Alison PhillipsEmail author
  • Elise A. G. Duwe
Concise Research Reports


Patient non-adherence to medications functions as a key mediator between medical practice and patient outcomes, occurring in 20–50% of patients.1 One point of intervention is the medical encounter.2 However, providers are hesitant to ask about non-adherence, which leads to poor prescribing decisions and missed opportunities for addressing non-adherence.3 Direct questions about non-adherence are not ideal, as they elicit “socially desirable” responses and are subject to poor recall.4

We explore the potential benefit of asking about patients’ medication-taking routines/habits for estimating adherence. This approach may avoid problems associated with direct questions—patients may not be able to accurately reflect on or wantto report specific instances of forgetting a pill, but could describe a “typical daily routine.” Further, patients’ behavioral habit strength (automaticity in taking medication) predicts adherence more strongly than commonly assessed cognitive predictors...


patient–provider communication medication adherence habit treatment routines medical encounter 



Dr. Howard Leventhal and Dr. Elaine Leventhal were involved in data collection and study design for the study of patients with hypertension. Dr. Joshua Cohen and Dr. Edith Burns were involved in the data collection and study design for the study of patients with type 2 diabetes.

Funding Information

Funds for the research came from internal funds, from Iowa State University to the first author. Funds for the study with patients on hypertension medications came from internal funding to the first author and Dr. Elaine Leventhal, from Rutgers University. Funds for the study with patients on type 2 diabetes medication came from the PhRMA Foundation.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    DiMatteo R, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: A meta-analysis. Med Care.2002;40:794–811.CrossRefPubMedGoogle Scholar
  2. 2.
    Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns.2009;74:295–301.CrossRefPubMedGoogle Scholar
  3. 3.
    Murri R, Antinori A, Ammassari A, Nappa S, Orofino G, Abrescia N, Mussini C, D’Arminio Monforte A, Wu AW, AdlCoNA Study Group. Physician estimates of adherence and the patient-physician relationship as a setting to improve adherence to antiretroviral therapy. J Acquir Immune Defic Syndr.2002;31:S158–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Phillips LA, Leventhal EA, Leventhal H. Factors associated with the accuracy of physicians’ predictions of patient adherence. Patient Educ Couns.2011;85(3):461–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Phillips LA, Cohen J, Burns EA, Abrams J, Renninger S. Self-management of chronic illness: The role of 'habit' vs reflective factors in exercise and medication adherence. J Behav Med.2016;39(6):1076–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Horne R. The medication adherence report scale. 2004. Brighton: University of Brighton.Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of PsychologyIowa State UniversityAmesUSA
  2. 2.Department of World Languages and CulturesIowa State UniversityAmesUSA
  3. 3.Northeast Iowa Family Medicine Education FoundationWaterlooUSA

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