Document Detail


Communication and medication refill adherence: the Diabetes Study of Northern California.
MedLine Citation:
PMID:  23277199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Poor medication refill adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking communication between patients and health care providers to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications.
METHODS: To investigate associations between patient communication ratings and cardiometabolic medication refill adherence, we conducted a cross-sectional analysis of 9377 patients in the Diabetes Study of Northern California (DISTANCE), a race-stratified, random sample of Kaiser Permanente survey respondents. Eligible participants received 1 or more oral hypoglycemic, lipid-lowering, or antihypertensive medication in the 12 months preceding the survey. Communication was measured with a 4-item Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) score and 4 items from the Trust in Physicians and Interpersonal Processes of Care instruments. Poor adherence was classified as greater than a 20% continuous medication gap for ongoing medication therapies. Using modified least squares regression, we calculated differences in poor adherence prevalence for a 10-point decrease in CAHPS score and compared higher vs lower communication ratings on other items, adjusting for necessary sociodemographic and medical confounders derived from a directed acyclic graph.
RESULTS: In this cohort, 30% had poor cardiometabolic medication refill adherence. For each 10-point decrease in CAHPS score, the adjusted prevalence of poor adherence increased by 0.9% (P=.01). Compared with patients offering higher ratings, patients who gave health care providers lower ratings for involving patients in decisions, understanding patients' problems with treatment, and eliciting confidence and trust were more likely to have poor adherence, with absolute differences of 4% (P=.04), 5% (P=.02), and 6% (P=.03), respectively. Associations between communication and adherence were somewhat larger for hypoglycemic medications than for other medications.
CONCLUSIONS: Poor communication ratings were independently associated with objectively measured inadequate cardiometabolic medication refill adherence, particularly for oral hypoglycemic medications. Future studies should investigate whether improving communication skills among clinicians with poorer patient communication ratings could improve their patients' cardiometabolic medication refill adherence and outcomes.
Authors:
Neda Ratanawongsa; Andrew J Karter; Melissa M Parker; Courtney R Lyles; Michele Heisler; Howard H Moffet; Nancy Adler; E Margaret Warton; Dean Schillinger
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-20     Completed Date:  2013-04-08     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  210-8     Citation Subset:  AIM; IM    
Affiliation:
General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF), San Francisco, CA 94110, USA. ratanawongsan@medsfgh.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / administration & dosage
Attitude of Health Personnel
Communication*
Cross-Sectional Studies
Decision Making
Diabetes Mellitus / drug therapy
Female
Humans
Hypoglycemic Agents / administration & dosage
Hypolipidemic Agents / administration & dosage
Male
Medication Adherence / psychology*,  statistics & numerical data
Middle Aged
Trust
Grant Support
ID/Acronym/Agency:
DK080726/DK/NIDDK NIH HHS; DK081796/DK/NIDDK NIH HHS; P30 DK092924/DK/NIDDK NIH HHS; P30DK092924/DK/NIDDK NIH HHS; R01 DK065664/DK/NIDDK NIH HHS; R01 DK080726/DK/NIDDK NIH HHS; R01 DK081796/DK/NIDDK NIH HHS; R01 DK65664/DK/NIDDK NIH HHS; R01 HD046113/HD/NICHD NIH HHS; R01 HD046113/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Hypoglycemic Agents; 0/Hypolipidemic Agents
Comments/Corrections
Comment In:
JAMA Intern Med. 2013 Feb 11;173(3):218-9   [PMID:  23277229 ]
Erratum In:
JAMA Intern Med. 2013 May 13;173(9):731

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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