OBJECTIVE: Our objectives were to examine how certain aspects of provider-patient communication recommended by national asthma guidelines (ie, provider asking for child and caregiver input into the asthma treatment plan) were associated with child asthma medication adherence 1 month after an audio-taped medical visit. METHODS: Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All medical visits were audio-tape recorded. Children were interviewed 1 month after their medical visits, and both children and caregivers reported the child’s control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence 1 month later. RESULTS: Children (n = 259) completed a home visit interview ∼1 month after their audio-taped visit, and 216 of these children were taking an asthma control medication at the time of the home visit. Children reported an average control medication adherence for the past week of 72%, whereas caregivers reported the child’s average control medication adherence for the past week was 85%. Child asthma management self-efficacy was significantly associated with both child- and caregiver-reported control medication adherence. When providers asked for caregiver input into the asthma treatment plan, caregivers reported significantly higher child medication adherence 1 month later. CONCLUSIONS: Providers should ask for caregiver input into their child’s asthma treatment plan because it may lead to better control medication adherence.

Objective The objective of the study was to examine the association between provider-patient communication, glaucoma medication adherence self-efficacy, outcome expectations, and glaucoma medication adherence. Design Prospective observational cohort study. Participants 279 patients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Methods Patients’ visits were video-tape recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits. Main outcome measures The following adherence variables were measured for the 60 day period after their visits: whether the patient took 80% or more of the prescribed doses, percent correct number of prescribed doses taken each day, and percent prescribed doses taken on time. Results Higher glaucoma medication adherence self-efficacy was positively associated with better adherence with all three measures. African American race was negatively associated with percent correct number of doses taken each day (beta= −0.16, p<0.05) and whether the patient took 80% or more of the prescribed doses (odds ratio=0.37, 95% confidence interval 0.16, 0.86). Physician education about how to administer drops was positively associated with percent correct number of doses taken each day (beta= 0.18, p<0.01) and percent prescribed doses taken on time (beta=0.15, p<0.05). Conclusions These findings indicate that provider education about how to administer glaucoma drops and patient glaucoma medication adherence self-efficacy are positively associated with adherence.

Providers should consider using tools to screen glaucoma patients for depressive symptoms and for problems in using medications to identify patients who are at higher risk of nonadherence to treatment and who might benefit from follow-up with primary care providers.

Significance This paper is the first to investigate the nature of medication cost discussions between ophthalmologists and glaucoma patients. Only 87 of the 275 office visits analyzed had a discussion of medication cost. Providers should consider discussing medication cost with patients to identify potential cost related barriers to medication use. Purpose Glaucoma is an incurable chronic eye disease affecting a growing portion of the aging population. Some of the most commonly utilized treatments require life-long use, requiring high patient adherence to ensure effectiveness. There are numerous barriers to glaucoma treatment adherence in the literature, including cost. The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. Methods: This was a mixed methods secondary analysis of video recorded participant office visits (n=275) from a larger observational study of glaucoma communication. We analyzed medical information, demographic characteristics, and interviewer-administrated questionnaires, as well as verbatim transcripts of interviews. Results Only 87 participants discussed medication cost during their glaucoma office visit. The majority of the subjects that discussed cost had mild disease severity (51%), took one glaucoma medication (63%) and had Medicare (49%) as well as a form of prescription insurance (78%). The majority of glaucoma office visits did not discuss medication cost and providers often did not ask about cost problems. Of the few conversations related to cost, most focused on providers offering potential solutions (n=50), medical and prescription service coverage (n=41), and brand or generic medication choices (n=41). Conclusions Our findings are similar to previous studies showing few patients have conversations with providers about the cost of glaucoma medications. Providers should consider bringing up medication cost during glaucoma office visits to prompt a discussion of potential cost related barriers to medication use.

Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8–16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider–child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.