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Do physicians communicate the adverse effects of medications that older patients want to hear?

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Abstract

Background and objectives

Physicians routinely discuss the adverse effects of medications but whether these discussions match older patients’ desire for information is an area that has not been explored. This study compares patient preferences for adverse effect discussions with reported physician practice.

Methods

A cross-sectional survey of a convenience sample of 100 practicing primary care physicians from nine medical groups, and 178 patients recruited from 11 senior centers in the Los Angeles metropolitan area. Physicians listed the adverse effects they typically discuss when prescribing an ACE inhibitor. Patients were given a hypothetical scenario about a new medication prescription and, from a list of adverse effects, they were then asked to circle the three they most wanted to hear about.

Results

More than 90 % of patients wanted a physician to discuss medication adverse effects; they wanted information about both dangerous (75 % of patients) and common (66 % of patients) adverse effects. However, patients most commonly chose to hear about adverse effects occurring for <1 % of patients, and selected a wide range of adverse effects for discussion. Physicians most frequently reported educating patients about adverse effects which were more common and life-threatening. Patients wishing to discuss additional adverse effects were more worried about adverse effects than those wishing to hear fewer (4.0 vs. 3.4 on a 5-point Likert scale; p = 0.02).

Conclusions

For the studied medication, there was little concordance between the medication adverse effects physicians say they discuss and what patients want to hear. Physicians cannot practically verbally satisfy patients’ information desires about the adverse effects of new medications during time-compressed office visits. Innovative solutions are needed.

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Acknowledgments

Derjung M. Tarn, Ariela Wenger, Jeffrey S. Good, Marc Hoffing, Joseph E. Scherger and Neil S. Wenger report no conflicts of interest or financial disclosures.

Dr. Tarn was supported by a University of California–Los Angeles Mentored Clinical Scientist Development Award (5K12AG001004), and by the University of California–Los Angeles Older Americans Independence Center (National Institutes of Health/National Institute on Aging grant P30-AG028748). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.

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Correspondence to Derjung M. Tarn.

Appendix: List of adverse effects provided to patients

Appendix: List of adverse effects provided to patients

The following table lists some of Boncordin’s potential adverse effects. Adverse effects are grouped into non-life-threatening adverse effects that are more or less common, as well as life-threatening adverse effects.

List of potential adverse effects of Boncordin presented to patients

More common adverse effects (% of occurrence)

Less common adverse effects (occur <1 % of the time)

Life-threatening adverse effects (occur <1 % of the time)

Cough (1–10 %)

Hair loss

Significant allergic reaction (anaphylaxis)

Headache (6 %)

Flushing

Swelling (including of head, neck and intestines)

Dizziness (4 %)

Joint pains/arthritis

Drowsiness (2 %)

Asthma

Shortness of breath

Worsening kidney function (reversible; doctor will check for this) (2 %)

Dermatitis (itchy skin)

Shock

Rash

Life-threatening rash in which your skin falls off

Numbness or tingling of skin

Muscle aches

Chest pain

Palpitations

Syncope (fainting)

EKG changes

Pancreatitis

Kidney failure

Impotence

Difficulty sleeping (insomnia)

Abnormal blood test: sodium

Abnormal white blood count

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Tarn, D.M., Wenger, A., Good, J.S. et al. Do physicians communicate the adverse effects of medications that older patients want to hear?. Drugs Ther Perspect 31, 68–76 (2015). https://doi.org/10.1007/s40267-014-0176-7

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  • DOI: https://doi.org/10.1007/s40267-014-0176-7

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