How Do Providers Assess Antihypertensive Medication Adherence in Medical Encounters?

Authors

  • Barbara G. Bokhour PhD,

    1. Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
    2. Boston University School of Public Health, Boston, MA, USA
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  • Dan R. Berlowitz MD, MPH,

    1. Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
    2. Boston University School of Public Health, Boston, MA, USA
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  • Judith A. Long MD,

    1. Philadelphia VA Center for Health Equity Research and Promotion, PA, Philadelphia, USA
    2. University of Pennsylvania School of Medicine, PA, Philadelphia, USA
    3. Leonard David Institute of Health Economics, PA, Philadelphia, USA
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  • Nancy R. Kressin PhD

    1. Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
    2. Boston University School of Public Health, Boston, MA, USA
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The authors have no conflicts of interest to report.Address correspondence and requests for reprints to Dr. Bokhour: Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Hospital (152), 200 Springs Road, Bedford, MA 01730 (e-mail: bokhour@bu.edu).

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.

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