Specific Patient-Cardiologist Discussions Needed to Fight Medication Nonadherence

Deborah Brauser

May 12, 2016

CHICAGO, IL — Not only are patients often not adhering to their cardioprotective medication, clinicians may not be aware which of their patients are nonadherent because of a lack of communication, new research suggests[1].

In a study that questioned 21 cardiologists and 66 of their outpatients, 61% of the latter said they had never or rarely discussed whether they were adhering to their medication—even though 55% reported just moderate adherence and 13% reported poor adherence.

Interestingly, all of the doctors said adherence discussions are important. However, 67% admitted not knowing how often their patients miss a dose and just one was able to identify a poorly adherent patient. The top reason given by the cardiologists for why they didn't have more medication adherence discussions was time.

"The novel design of our research identified an important yet neglected aspect of clinical practice," write the investigators, led by Rosemary Hines (Northwestern University, Feinberg School of Medicine, Chicago, IL).

Because of the findings, "we recommend that physicians include a highly specific question about adherence to medication at every patient visit," they write, adding that it would only add a few seconds to a patient's visit. That simple question is, "How many of your heart medications have you missed in the past 30 days?"

Primary investigator Dr Neil J Stone (Northwestern Memorial Hospital) told heartwire from Medscape that although one question can't address all issues, it's a great starting place and could help determine why a previously "good adherer" had missed one or more doses.

"Most people will say 'yes' when you ask if they're taking their medication regularly. But asking more specifically will often result in a different answer," said Stone. "In our study, our results were quite striking."

The findings were published online May 11, 2016 in JAMA Cardiology.

How to Improve Adherence?

"We've known for years that adherence, especially to cardiovascular medications, is not very good," said Stone. "So we wanted to find out what could we do to improve that."

In the study, "paired patient and physician questionnaires were developed based on the 8-item Morisky Medication Adherence Scale," note the investigators. They were distributed between June and July 2015 to physicians (75% men) and outpatients (65% men; mean age 71.6 years) at four centers in Chicago.

Stone further explained that Hines administered the questionnaires to patients right before a clinical visit and then interviewed their physicians after the visit. "This was designed to remove any recall bias," he said.

Among the 40 patients reporting the least adherence talks with their physicians, 18 said "sometimes or usually" they forgot to take their medication, with four saying they'd missed at least one dose during the previous 2 weeks. Only one of the eight patients reporting the poorest adherence was correctly identified by their caregiver as being poorly adherent.

Among the physicians, 38% (n=8) admitted wanting to discuss patient adherence but not doing so. Of these eight cardiologists, five said not having enough time was the reason this occurred, whereas the other three cited their belief that a patient "had more important problems to be addressed."

"Important Implications"

"Our study, albeit brief, has important implications," write the researchers. "A detailed question about adherence . . . may prevent the addition of medications to a patient's treatment regimen when all that is needed is better adherence to the patient's existing regimen."

They add that things like insurance changes or travel obligations can cause patients to stop being as careful with taking their medications, which they often don't think about reporting. However, even one missed dose can lead to abnormalities.

"This was a small study and didn't begin to address all the problems with adherence. But it points out that an important way to start is for clinicians and patients to both acknowledge at each visit what the patient's adherence is," said Stone.

Overall, "we're urging that a more specific question be asked in a standardized way at the start of each visit so it's just part of the data."

Hines and Stone report no relevant financial disclosures.

Follow Deborah Brauser on Twitter: @heartwireDeb. For more from theheart.org, follow us on Twitter and Facebook.

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