Patient compliance highest with compatible physicians
■ Physicians and patients who have similar beliefs about a patient's role in managing health achieve better outcomes, says a new study.
By Kevin B. O’Reilly — Posted May 17, 2010
Patients with chronic conditions such as hypertension or diabetes are more likely to stick to treatment if they believe they have personal control over their health, previous research has shown. Now a new study finds that patients whose beliefs about health control match their physicians' beliefs do even better, achieving lower blood pressure and refilling their medications more often than do patients at odds with their doctors.
The research highlights how important it is for physicians to communicate better with patients and tailor approaches to managing chronic disease to patients' personal beliefs, said Gary E. Rosenthal, MD, co-author of the study in the May Journal of General Internal Medicine.
"This shows that symmetry in the beliefs that patients and physicians might have about the patients' role in health care can have an influence on important treatment outcomes," said Dr. Rosenthal, director of the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa Veterans Affairs Medical Center. "The delivery of health care is contextual, and there are a lot of factors that go into producing effective patient-physician communication."
Researchers asked 246 patients and the 18 primary care physicians caring for them at the Iowa VA Medical Center how much they agreed with a series of statements about patients' control over health. For example, one statement said, "If patients take the right actions, they can stay healthy."
Then, researchers examined electronic pharmacy records to see when patients refilled medications and used that data to calculate a "medication possession ratio" showing how often patients had medicines on hand.
The study found that patients who believed their actions caused a high amount of control but were seeing doctors with low-control beliefs did not have medication on hand 18% of the time during the 13-month study. This was a refill nonadherence rate 50% higher than for patients who were in sync with their physicians.
Patients with high-control views cared for by physicians with low-control beliefs had an average diastolic blood pressure of 74 mmHg, 4.5% higher than the average rate of 71 seen among patients who shared their doctors' attitudes.
Patients who place a lot of importance on controlling their health may react in a "maladaptive" way -- such as not refilling prescriptions -- when physicians fail to take their attitudes into account, said Alan J. Christensen, PhD, the study's lead author.
"The nonadherence itself can be a way for the patient to restore some sense of control," said Christensen, chair of the University of Iowa Dept. of Psychology and senior scientist at the Center for Research in the Implementation of Innovative Strategies in Practice.
Patients don't all have the same views of how they want to manage their health, he said. "One patient's empowerment is another patient's burden."
Yet it is difficult for physicians to determine what patients believe about how active a role they want to take in managing their conditions or if they need additional support from nursing or extra office visits, Christensen said.
"It has become clear in our work that it doesn't appear that most physicians are able to tailor their approach in ways that seem most conducive to matching patient preferences and attitudes, and that are ultimately most conducive to promoting patient adherence and better clinical outcomes," Christensen said. "Physicians, of course, are very busy, and time spent with patients is getting shorter and shorter, so they spend time on the narrower range of things that seem the most clinically acute."
The next research step, Christensen said, is to implement a screening tool for physicians to assess their patients' health-control beliefs and see if that knowledge helps physicians tailor care to improve medication adherence and clinical outcomes.