Open Access Open Access  Restricted Access Subscription or Fee Access

Talking about medicines: Older adults’ perceptions of communication with their physicians

Roberta E Goldman, Brian J. Quilliam, Kate L. Lapane

Abstract


Objective:  Discussions between physicians and patients in primary care regarding medications and lifestyle change alternatives are often suboptimal, resulting in poor adherence to medication therapy.  Our objective was to investigate perceptions of communication with physicians about medications among a racially/ethnically diverse sample of low-income older adults in the U.S..

Methods: We recruited a stratified purposeful sample of 105 low-income participants (predominantly Latino, non-Hispanic White, and non-Hispanic Black) for 11 focus groups, conducted from November 2007 through March 2008.

Results: Most participants claimed that their primary care physicians rarely explained much about their medications and they reported little understanding of the medical benefits of each medication they are prescribed.  Few said that their physician asked them if they have any problems with their medications. Latinos described receiving more frequent and substantive information from physicians about medication than did white or black participants.  Many participants expressed their preference to try lifestyle behavior changes to avoid taking medications, however few of their physicians had discussed this option with them.  Most participants believed that their medical chart accurately reflects the medications and dosages they are taking, even if they have not reviewed the medications with their physicians, nor told them about medications that have been prescribed by other physicians and how they actually take their medications. 

Conclusions: Educational efforts are needed to empower low-income, diverse, older patients to initiate and participate in multi-faceted discussions regarding medications with their physicians, and to motivate physicians to include these discussions more regularly in their outpatient visits.


Full Text:

PDF

References


Cherry DK, Burt CW, Woodwell DA. (2003) National ambulatory medical care survey: 2001 Summary. Advanced Data, 1-44.

Makoul G, Arntson P, Schofield T. (1995) Health promotion in primary care: physician-patient communication and decision making about prescription medications. Social Science and Medicine 41, 1241-54.

Richard C, Lussier MT. (2007) Measuring patient and physician participation in exchanges on medications: dialogue ratio, preponderance of initiative, and dialogical roles. Patient Education and Counseling 65, 329-41.

Metlay JP, Cohen A, Polsky D, Kimmel SE, Koppel R, Hennessy S. (2005) Medication safety in older adults: home-based practice patterns. Journal of the American Geriatrics Society 53, 976-82.

Lewis LM. (2011) Factors associated with medication adherence in hypertensive blacks: A review of the literature. Journal of Cardiovascular Nursing.

Wiederholt JB, Clarridge BR, Svarstad BL. (1992) Verbal consultation regarding prescription drugs: findings from a statewide study. Medical Care 30, 159-73.

Copher R, Buzinec P, Zarotsky V, Kazis L, Iqbal SU, Macarios D. (2010) Physician perception of patient adherence compared to patient adherence of osteoporosis medications from pharmacy claims. Current Medical Research and Opinion 26, 777-85.

Friedman DS, Hahn SR, Quigley HA, et al. (2009)Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. Ophthalmology 116, 2277-85 e1-3.

Dailey R, Schwartz KL, Binienda J, Moorman J, Neale AV. (2006) Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians. Journal of the National Medical Association 98, 1895-903.

Eaton CB, Goodwin MA, Stange KC. (2002) Direct observation of nutrition counseling in community family practice. American Journal of Preventive Medicine 23, 174-9.

Cohen SM. (2009) Concept analysis of adherence in the context of cardiovascular risk reduction. Nursing Forum 44, 25-36.

Pappachan JM, Chacko EC, Arunagirinathan G, Sriraman R. (2011) Management of hypertension and diabetes in obesity: non-pharmacological measures. International Journal of Hypertension, 398065.

Miller ER, 3rd, Erlinger TP, Young DR, et al. (2002) Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 40, 612-8.

McCaffree J. (2003) Position of the american dietetic association: integration of medical nutrition therapy and pharmacotherapy. Journal of the American Dietetic Association 103, 1363-70.

Harsha DW, Sacks FM, Obarzanek E, et al. (2004) Effect of dietary sodium intake on blood lipids: results from the DASH-sodium trial. Hypertension 43, 393-8.

Berry D, Michas I, Gillie T, Forster M. (1997) What do patients want to know about their medicines and what do doctors want to tell them? A comparative study. Psychology, Health & Medicine 12, 467-80.

Stevenson FA, Cox K, Britten N, Dundar Y. (2004) A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect 7, 235-45.

Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. (2006) Physician communication when prescribing new medications. Archives of Internal Medicine 166, 1855-62.

Berry DC, Knapp P, Raynor DK. (2002) Provision of information about drug side-effects to patients. Lancet 359, 853-4.

Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH. (2003) The costs associated with adverse drug events among older adults in the ambulatory setting. Medical Care 43, 1171-6.

Gandhi TK, Weingart SN, Borus J, et al. (2003) Adverse drug events in ambulatory care. The New England Journal of Medicine 348, 1556-64.

Bedell SE, Jabbour S, Goldberg R, et al. (2000) Discrepancies in the use of medications: their extent and predictors in an outpatient practice. Archives of Internal Medicine 160, 2129-34.

Kaboli PJ, McClimon BJ, Hoth AB, Barnett MJ. (2004) Assessing the accuracy of computerized medication histories. American Journal of Managed Care 10, 872-7.

Bikowski RM, Ripsin CM, Lorraine VL. (2001) Physician-patient congruence regarding medication regimens. Journal of the American Geriatrics Society 49, 1353-7.

Tulner LR, Kuper IM, Frankfort SV, van Campen JP, Koks CH, Brandjes DP, Beijnen JH. (2009) Discrepancies in reported drug use in geriatric outpatients: relevance to adverse events and drug-drug interactions. The American Journal of Geriatric Pharmacotherapy 7, 93-104.

Green JL, Hawley JN, Rask KJ. (2007) Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? The American journal of Geriatric Pharmacotherapy 5, 31-9.

Avorn J. (2010) Medication use in older patients: better policy could encourage better practice. Journal of the American Medical Association 304, 1606-7.

Kuzel A. (1999) Sampling in Qualitative Inquiry. In: Doing Qualitative Research. Crabtree B, Miller M, eds, Thousand Oaks, CA: Sage Publications.

Bajcar J. (2006) Task analysis of patients' medication-taking practice and the role of making sense: a grounded theory study. Res Social Adm Pharm 2, 59-82.

Krueger R. (1994) Focus Groups: A Ratical Guide for Applied Research. Thousand Oaks, CA: Sage Publications.

Borkan JM. (1999) Immersion/Crystallization. Thousand Oaks, CA: Sage Publications.

WEFT, QDA. Qualitative Analysis Software. http://www.pressure.to/qda/

Mutchler JE, Bacigalupe G, Coppin A, Gottlieb A. (2007) Language barriers surrounding medication use among older Latinos. Journal of Cross-Cultural Gerontology 22, 101-14.

David RA, Rhee M. (1998) The impact of language as a barrier to effective health care in an underserved urban Hispanic community. The Mount Sinai Journal of Medicine, New York 65, 393-7.

Lopez-Quintero C, Berry EM, Neumark Y. (2009) Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States. Journal of the American Dietetic Association 109, 1769-74.

Eamranond PP, Davis RB, Phillips RS, Wee CC. (2009) Patient-physician language concordance and lifestyle counseling among Spanish-speaking patients. Journal of Immigrant and Minority Health / Center for Minority Public Health 11, 494-8.

Lopez-Quintero C, Crum RM, Neumark YD. (2006) Racial/ethnic disparities in report of physician-provided smoking cessation advice: analysis of the 2000 National Health Interview Survey. American Journal of Public Health 96, 2235-9.

Johnson-Kozlow M, Roussos S, Rovniak L, Hovell M. (2009) Colorectal cancer test use among Californians of Mexican origin: influence of language barriers. Ethnicity and Disease 19, 315-22.

Tessema J, Jefferds ME, Cogswell M, Carlton E. (2009) Motivators and barriers to prenatal supplement use among minority women in the United States. Journal of the American Dietetic Association 109, 102-8.

Clark T, Sleath B, Rubin RH. (2004) Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior. Patient Education and Counseling 53, 87-93.

Moore S, Bockenholt U, Daniel M, Frohlich K, Kestens Y, Richard L. (2011) Social capital and core network ties: a validation study of individual-level social capital measures and their association with extra- and intra-neighborhood ties, and self-rated health. Health & Place 17, 536-44.

Moreno G, Tarn DM, Morales LS. (2009) Impact of interpreters on the receipt of new prescription medication information among Spanish-speaking Latinos. Medical Care 47, 1201-8.

Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. (2010) Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. American Journal of Kidney Disease, 56, 439-46.

Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. (2003) Fleeting glimpses of shared decision making: developing the OPTION scale for measuring patient involvement. Quality & Safety in Health Care 12, 93-9.

Cox K, Stevenson F, Britten N. (2002) A systemic review of communication between patients and health care professionals about medicine-taking and prescribing. In: Unit GC, ed.

Stevenson FA. (2001) The strategies used by general practitioners when providing information about medicines. Patient Education and Counseling 43, 97-104.

Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP. (2000) Doctor-patient communication about drugs: the evidence for shared decision making. Social Science and Medicine 50, 829-40.

Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, Epstein RM. (2004) Patient trust: is it related to patient-centered behavior of primary care physicians? Medical Care 42, 1049-55.

Sarradon-Eck A, Egrot M, Blance MA, Faure M. (2010) Anthropological approach of adherence factors for antihypertensive drugs. Health Policy 5, e157-75.

Tucker CM, Marsiske M, Rice KG, Nielson JJ, Herman K. (2011) Patient-centered culturally sensitive health care: model testing and refinement. Health Psychology 30, 342-50.

Hahn SR. (2009) Patient-centered communication to assess and enhance patient adherence to glaucoma medication. Ophthalmology 116, S37-42.

Banning M. (2008) Older people and adherence with medication: a review of the literature. International Journal of Nursing Studies 45, 1550-61.

Young S, Oppenheimer DM. (2009) Effect of communication strategy on personal risk perception and treatment adherence intentions. Psychol Health Med 14, 430-42.

Cooper L, Roter D, Bone L, et al. (2009) A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence, and high blood pressure control among ethnic minorities and poor persons: A study protocol NCT00123045. Implemental Science 19, 7.

Shrank WH, Cadarette SM, Cox E, et al. (2009) Is there a relationship between patient beliefs or communication about generic drugs and medication utilization? Medical Care 47, 319-25.

Schoenthaler A, Chaplin WF, Allegrante JP, Fernandez S, Diaz-Gloster M, Tobin JN, Ogedegbe G. (2009) Provider communication effects medication adherence in hypertensive African Americans. Patient Education and Counseling 75, 185-91.

Haskell WL. (2003) Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy. Journal of Cardiovascular Nursing 18, 245-55.

Tarn DM, Paterniti DA, Kravitz RL, Fein S, Wenger NS. (2009) How do physicians conduct medication reviews? Journal of General Internal Medicine 24, 1296-302.

Erickson S, Hambleton J. (2011) A pharmacy's journey toward the patient-centered medical home. Journal of the American Pharmaceutical Association (2003) 51, 156-60.

NCQA. (2011) Standards for Patient Centered Medical Home. Washington, DC.

Gurwitz JH, Field TS, Harrold LR, et al. (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Journal of the American Medical Association 289, 1107-16.

Aspden P, Wolcott J, Bootman L, Cronenwett L. (2006) Preventing Medication Errors. Washington, DC: Institute of Medicine of the National Academies Press.

Spinewine A, Swine C, Dhillon S, Franklin BD, Tulkens PM, Wilmotte L, Lorant V. (2005) Appropriateness of use of medicines in elderly inpatients: qualitative study. British Medical Journal (Clinical research ed) 331, 935.




DOI: http://dx.doi.org/10.5750/ijpcm.v2i3.134

Refbacks

  • There are currently no refbacks.