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Am Fam Physician. 2007;75(5):722-723

Background: Medication use in the United States has increased in the past few years. Nearly one half of Americans take one or more prescription medications, and one half of older Americans take at least three. These medications are effective at treating diseases, but a significant number of patients do not take them as prescribed, which can cause many adverse events. A patient's nonadherence to a medication regimen could be related to a fear of medicine interactions, adverse effects, a perceived lack of effectiveness, misunderstandings about the need to take the medications, or financial issues. Patients who are provided with more information and those who communicate directly with their physician about how to take their medication are more compliant than those whose physician has not communicated with them. Tarn and associates assessed the quality of physician communication and its effect on patient adherence to newly prescribed medication regimens.

The Study: The study analyzed the communication between 16 family physicians, 18 internists, 11 cardiologists, and their patients in two health care systems. Survey data were gathered from the physicians before and after each patient visit, whereas the patients were surveyed only before the visit. In a randomized sample of patients, the physician-patient encounter was audio-taped and notes from the office visit were transcribed. The physicians then were asked to identify which of the patient encounters had included a new prescription. Using the Medication Communication Index (see accompanying table), the reviewers evaluated the quality of the physician's communication with the patient about the new medication.

Name of medication
Purpose or justification of the medication
Duration of medication intake
Direction for medication use:
Number of tablets or sprays
Frequency or timing of intake
Any adverse effects

Results: The study included 185 visits, and 243 new medications were prescribed to patients. The specific name of the medication was discussed with the patient in 74 percent of the encounters, and the purpose of the medication was given to the patient 87 percent of the time. How long to take the medication and its potential adverse effects were discussed 34 and 35 percent of the time, respectively. Physicians indicated dosage to the patient 55 percent of the time and explained the frequency of dosing 58 percent of the time. Physicians counseled patients most often when prescribing new psychiatric medications.

Conclusion: Physicians often fail to communicate important elements of medication use when prescribing new medications, which may increase the risk of patient misunderstanding. It also could increase the risk for nonadherence to new medication regimens and lead to adverse outcomes.

editor's note: Patient compliance with medications involves multiple factors that can have a positive or negative influence on adherence to physician recommendations. In an accompanying editorial about improving medication adherence, many challenges for physicians, payers, and policy makers are noted.1 Tarn and colleagues demonstrated that physicians play an important role in patient compliance. If physicians do not take the time to communicate the importance of medication adherence, how can they expect their patients to be compliant? There are many challenges to improving patient adherence to medications, but physicians can make a difference by taking a few minutes to educate their patients about the medications they have been prescribed.—k.e.m.

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