Provider Views About Responsibility for Medication Adherence and Content of Physician–Older Patient Discussions

Authors

  • Derjung M. Tarn MD, PhD,

    Corresponding author
    • Department of Family Medicine
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  • Thomas J. Mattimore MD,

    1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Douglas S. Bell MD, PhD,

    1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
    2. RAND Corporation, Santa Monica, California
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  • Richard L. Kravitz MD, MSPH,

    1. Division of General Medicine
    2. Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California
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  • Neil S. Wenger MD, MPH

    1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Address correspondence to Derjung M. Tarn, David Geffen School of Medicine at UCLA, Department of Family Medicine, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024. E-mail: dtarn@mednet.ucla.edu

Abstract

Objectives

To investigate provider opinions about responsibility for medication adherence and examine physician–patient interactions to illustrate how adherence discussions are initiated.

Design

Focus group discussions with healthcare providers and audio taped outpatient office visits with a separate group of providers.

Setting

Focus group participants were recruited from multispecialty practice groups in New Jersey and Washington, District of Columbia. Outpatient office visits were conducted in primary care offices in Northern California.

Participants

Twenty-two healthcare providers participated in focus group discussions. One hundred patients aged 65 and older and 28 primary care physicians had their visits audio taped.

Measurements

Inductive content analysis of focus groups and audio taped encounters.

Results

Focus group analyses indicated that providers feel responsible for assessing medication adherence during office visits and for addressing mutable factors underlying nonadherence, but they also believed that patients were ultimately responsible for taking medications and voiced reluctance about confronting patients about nonadherence. The 100 patients participating in audio taped encounters were taking a total of 410 medications. Of these, 254 (62%) were discussed in a way that might address adherence; physicians made simple inquiries about current patient medication use for 31.5%, but they made in-depth inquiries about adherence for only 4.3%. Of 39 identified instances of nonadherence, patients spontaneously disclosed 51%.

Conclusion

The lack of intrusive questions about medication taking during office visits may reflect poor provider recognition of the questions needed to assess adherence fully. Alternatively, provider beliefs about patient responsibility for adherence may hinder detailed queries. A paradigm of joint provider–patient responsibility may be needed to better guide discussions about medication adherence.

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