Clinicians' communication skills may affect medication refill adherence

Patients with diabetes who rated their clinicians as poor communicators were less likely to refill cardiometabolic medications in a timely manner, a study found.

Researchers performed a cross-sectional analysis of 9,377 patients from the Diabetes Study of Northern California, which comprised randomly sampled respondents from a Kaiser Permanente survey. Patients took one or more oral hypoglycemic, lipid-lowering or antihypertensive medication in the 12 months before the survey. Researchers had patients measure the communication of their clinicians via four items on the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) score and four items from the Trust in Physicians and Interpersonal Processes of Care instruments. They used pharmacy data to help determine adherence, which was measured via a “continuous medication gap” (CMG). The CMG is the proportion of days without enough medication across different refill intervals. Poor adherence was defined as more than a 20% CMG.

Thirty percent of the patients in the analysis had poor refill adherence for their medication(s). For each 10-point decline in CAHPS score, adjusted prevalence of poor adherence went up by 0.9% (P=0.01). Patients were more likely to have poor adherence if they gave their clinicians lower ratings for involving patients in decisions (4% adjusted difference in ratings; P=0.04), understanding patients' problems with treatment (5% adjusted difference; P=0.02) and eliciting confidence and trust (6% adjusted difference; P=0.03) than if they gave higher ratings. The association between adherence and communication was stronger for hypoglycemic medications than other medications. Results were published online Dec. 31 by Archives of Internal Medicine.

The results suggest patient communication ratings are “modestly predictive” of inadequate adherence to medication refills, the authors wrote, though it is unclear whether clinician communication can be modified or if doing so would improve adherence. Targeting clinicians with poorer communication ratings, or focusing on specific skills related to shared decision making, may be helpful, they added.

Editorialists noted that the study had several “methodological strengths that further its relevance and importance,” including use of objective pharmacy data, a large and diverse study population, and sophisticated analytical methods. The study is “an important stop on the road to patient centeredness,” they noted, adding that it is also important for patients to take responsibility for their health.