Addressing the Social Needs of Hypertensive Patients: The Role of Patient–Provider Communication as a Predictor of Medication Adherence

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Abstract

Background—

Poor medication adherence is a pervasive problem in patients with hypertension. Despite research documenting an association between patient–provider communication and medication adherence, there are no empirical data on how the informational and relational aspects of communication affect patient’s actual medication-taking behaviors. The aim of this study was to evaluate the impact of patient–provider communication on medication adherence among a sample of primary care providers and their black and white hypertensive patients.

Methods and Results—

Cohort study included 92 hypertensive patients and 27 providers in 3 safety-net primary care practices in New York City. Patient–provider encounters were audiotaped at baseline and coded using the Medical Interaction Process System. Medication adherence data were collected continuously during the 3-month study with an electronic monitoring device. The majority of patients were black, 58% women, and most were seeing the same provider for at least 1 year. Approximately half of providers were white (56%), 67% women, and have been in practice for an average of 5.8 years. Fifty-eight percent of patients exhibited poor adherence to prescribed antihypertensive medications. Three categories of patient–provider communication predicted poor medication adherence: lower patient centeredness (odds ratio: 3.08; 95% confidence interval: 1.04–9.12), less discussion about patients’ sociodemographic circumstances (living situation, relationship with partner; odds ratio: 6.03; 95% confidence interval: 2.15–17), and about their antihypertensive medications (odds ratio: 6.48; 95% confidence interval: 1.83–23.0). The effect of having less discussion about patients’ sociodemographic circumstances on medication adherence was heightened in black patients (odds ratio: 8.01; 95% confidence interval: 2.80–22.9).

Conclusions—

The odds of poor medication adherence are greater when patient–provider interactions are low in patient centeredness and do not address patients’ sociodemographic circumstances or their medication regimen.

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