How do providers assess antihypertensive medication adherence in medical encounters?

  • Barbara G. Bokhour
  • Dan R. Berlowitz
  • Judith A. Long
  • Nancy R. Kressin
Original Articles

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.

Key words

hypertension medication adherence provider-patient communication 

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 5.
    Jamerson K, DeQuattro V. The impact of ethnicity on response to antihypertensive therapy. Am J Med. 1996;101:22S-32S.CrossRefPubMedGoogle Scholar
  6. 6.
    Winickoff R. The persistent problem of poor blood pressure control. Arch Intern Med. 1987;147:1393–6.CrossRefPubMedGoogle Scholar
  7. 7.
    NHLBI Working Group. Management of patient compliance in the treatment of hypertension: report of the NHLBI working group. Hypertension. 1982;4:415–23.Google Scholar
  8. 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. 9.
    Clark LT. Improving compliance and increasing control of hypertension: needs of special hypertensive populations. Am Heart J. 1991;121(suppl):664.CrossRefPubMedGoogle Scholar
  10. 10.
    Gallup G, Cotugno H. Preferences and practices of Americans and their physicians in antihypertensive therapy. Am J Med. 1986;81:20–4.CrossRefPubMedGoogle Scholar
  11. 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.Google Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Kjellgren K, Svensson S, Ahlner J, Saljo R. Antihypertensive medication in clinical encounters. Int J Cardiol. 1998;64:161–9.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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. 19.
    Schiffrin D. Approaches to Discourse. Cambridge, MA: Blackwell Publishers; 1994.Google Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 23.
    Mead M, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.CrossRefPubMedGoogle Scholar
  24. 24.
    Kjellgren K, Ahlenr J, Saljo R. Taking antihypertensive medication — controlling or co-operating with patients. Int J Cardiol. 1995;47:257–68.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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. 28.
    Lee R, Garvin T. Moving from information transfer to information exchange in health and health care. Soc Sci Med. 2003;56:449–64.CrossRefPubMedGoogle Scholar
  29. 29.
    Conrad P. The meaning of medications: another look at compliance. Soc Sci Med. 1985;20:29–37.CrossRefPubMedGoogle Scholar
  30. 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

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Barbara G. Bokhour
    • 5
    • 1
  • Dan R. Berlowitz
    • 5
    • 1
  • Judith A. Long
    • 2
    • 3
    • 4
  • Nancy R. Kressin
    • 5
    • 1
  1. 1.Boston University School of Public HealthBostonUSA
  2. 2.Philadelphia VA Center for Health Equity Research and PromotionPhiladelphiaUSA
  3. 3.University of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Leonard David Institute of Health EconomicsPhiladelphiaUSA
  5. 5.Center for Health Quality, Outcomes and Economic ResearchENRM Veterans Hospital (152)Bedford

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