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

Published in: Journal of the American Geriatrics Society, v. 60, no. 6, June 2012, p. 1019-1026

Posted on RAND.org on June 01, 2012

by Derjung M. Tarn, Thomas J. Mattimore, Douglas S. Bell, Richard L. Kravitz, Neil S. Wenger

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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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