Communication is Key to Medication Adherence

Even the best medicines in the world can be rendered ineffective if they are not taken as prescribed. The problem known as medication “non-adherence” is a major health issue in the United States, contributing to worse outcomes for people who have diabetes and other chronic diseases.

Now a study led by researchers at the University of California, San Francisco (UCSF), San Francisco General Hospital and Trauma Center (SFGH) and the Kaiser Permanente Division of Research has identified a significant factor that contributes to poor drug adherence – ineffective communication.

Described in the journal JAMA Internal Medicine, formerly known as the Archives of Internal Medicine, the study looked at 9,377 patients taking medications to lower their blood sugar, blood pressure or cholesterol.

Neda Ratanawongsa, MD, MPH

These patients were asked through questionnaires to rate how well their doctors communicated with them. Patient medication adherence was determined by measuring delays in refilling prescriptions. The patients who gave their doctors poor marks in communicating were less likely to adhere to their medications.

The work suggests preparing doctors to be better communicators may help improve medication adherence and ultimately health outcomes, said lead author Neda Ratanawongsa, MD, MPH, an assistant professor in the UCSF Department of Medicine and the UCSF Center for Vulnerable Populations at SFGH.

“Communication matters,” Ratanawongsa said. “Thirty percent of people [in the study] were not necessarily taking their medications the way their doctors thought they were. Rates for non-adherence were 4 to 6 percent lower for patients who felt their doctors listened to them, involved them in decisions and gained their trust. By supporting doctors in developing meaningful relationships with their patients, we could help patients take better care of themselves.”

The work is part of the Diabetes Study of Northern California (DISTANCE), which is designed to evaluate quality of care and to identify reasons for disparities where they exist.

“What is unique about our study is that we found that medication adherence is better if the physician has established a trusting relationship with the patient and prioritizes the quality of communication, even if that communication is not specifically focused on medication adherence,” added Andrew Karter, PhD, a senior research scientist with the Kaiser Permanente Division of Research and the principal investigator of DISTANCE.

The article, “Communication and Medication Adherence: The Diabetes Study of Northern California” is authored by Neda Ratanawongsa, Andrew J. Karter, Melissa M. Parker, Courtney R. Lyles, Michele Heisler, Howard H. Moffet, Nancy Adler, E. Margaret Warton and Dean Schillinger. It was published by JAMA’s Archives of Internal Medicine on Dec. 31, 2012.

In addition to UCSF and Kaiser Permanente, authors on this study are affiliated with the University of Washington in Seattle, the University of Michigan, Ann Arbor Veterans Affairs Health Care System in Michigan and the California Department of Public Health.

The work was supported by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) through grant R01 DK65664, R01 DK081796, R01 DK080726 and P30DK092924. Additional support was provided by the National Institute of Child Health and Human Development through grant R01 HD046113. Both NIDDK and NICHD are institutes within the National Institutes of Health.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.