Posted Oct 21 , 2016 03:51 AM

Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians

Sidorkiewicz S, et al.  Annals of Family Medicine 2016;14:415

What were the findings (excerpted from the Abstract)?

Among patients on long-term medication therapy, this study compared (1) patient and physician assessments of drug adherence and of drug importance and (2) drug adherence reported by patients with drug importance as assessed by their physicians. The study recruited patients who were receiving at least 1 long-term drug treatment from both hospital and ambulatory settings in France. The authors compared drug adherence reported by patients and drug importance assessed by physicians using Spearman correlation coefficients. Reasons for non-adherence were collected with open-ended questions and classified as intentional or unintentional. Between April and August 2014, the investigators recruited 128 patients taking 498 drugs. Patients and physicians showed only weak agreement in their assessments of drug adherence (r = –0.25) and drug importance (r = 0.07), and the authors did not find any correlation between physician-assessed drug importance and patient-reported drug adherence (r = –0.04).  In all, 94 (18.9%) of the drugs that physicians considered important were not correctly taken by patients. Patients intentionally did not adhere to 26 (48.1%) of the drugs for which they reported reasons for non-adherence, the most common reason being medication side effects.

Why is this important?

The authors found substantial discordance between patient and physician evaluations of drug adherence and drug importance. Nearly 20% of drugs considered important by physicians were not correctly taken by patients. These findings highlight the need for better patient-provider collaboration in drug treatment.  Assessing drug adherence in primary care settings in a nonthreatening way and recognizing the challenges of taking medications regularly may help facilitate discussion about medications and about patient knowledge and beliefs about their medications or their disease conditions in general.  One way to bridge the gap between patients and providers would be to encourage collaboration between all health professionals involved in ambulatory care. For example, Pharmacist counseling has been shown to be effective to improve patient adherence and health outcomes (Ose D, et al. Patient Prefer Adherence. 2012;6:839).  The role of pharmacists ranges from dispensing medication to counseling patients. Using their drug expertise, they may also be useful to physicians by ensuring that drugs do not interact in a harmful way, or by advising physicians or other providers on medications. Do you regularly assess patient medication adherence? Do you engage pharmacists to assess or counsel patients on medication adherence? 

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