Medication Risk Communication During Rheumatology Office Visits

Abstract

Objective. We used a multidimensional framework to describe the types of information about medication risks that rheumatologists provide to rheumatoid arthritis (RA) patients during routine office visits. Methods. We analyzed 1,094 audiotaped rheumatology office visits involving 450 RA patients. Each patient had up to 3 visits audiotaped. In conjunction with each office visit, patients also completed a self-administered questionnaire and interview and the rheumatologists provided ratings of patient health status. Results. The number of medication risks discussed per visit ranged from 0 -18, with a mean ؎ SD of 3.23 ؎ 2.93. The rheumatologist initiated ϳ80% of the medication risk discussions. Approximately one-fourth of the discussions (25.6%) were limited to an assessment of whether or not the patient was experiencing a medication side effect. More risks were discussed during visits when changes to the patient's regimen were discussed than when no changes were discussed (X ‫؍‬ 3.93, SD ‫؍‬ 3.10 and X ‫؍‬ 2.20, SD ‫؍‬ 2.34, respectively; P < 0.0001). When medications were being proposed for addition to the patient's regimen, the most frequently discussed risk dimensions were the importance of monitoring (30%), probability (29.8%), things the patient should do to minimize risk (25.5%), and risk severity (21.8%). Conclusion. Most discussions of medication risks that we observed were quite limited and often restricted to an assessment of whether the patient was experiencing side effects from their current medications. The amount of information that is optimal and how to tailor information to the preferences and abilities of individual patients remain important areas for future research. INTRODUCTIONMedications play an important role in the effective management of rheumatoid arthritis (RA) (1). Current guidelines call for the aggressive treatment of early RA with disease-modifying antirheumatic drugs (DMARDs) to prevent disease progression (2). However, the benefits associated with aggressive therapy are accompanied by potentially serious risks (3). Therefore, patients need to have a clear understanding of both the risks and benefits associated with different treatment options in order to make informed decisions among therapeutic alternatives. Although a large body of literature on perceived risk and risk communication exists (4), few of these studies have focused on patient-provider communication about medication risks, especially within the context of musculoskeletal disorders (5,6). We know from research in other areas that almost all patients express a desire for information about available treatment options (7) and that most patients want information about treatment risks (8,9). For example, in a study of patients visiting outpatient clinics, Ziegler and colleagues found that 76.2% of patients wanted information about all possible adverse medication effects, no matter how rare (8). Fraenkel and colleagues (9) reported similar findings in a study involving RA patients.Despite patient interest in detailed informat...

Gist and verbatim communication concerning medication risks/benefits

“…Two separate coding schemes were developed and used to analyze the transcripts. Because both coding schemes have been described in previous publications [25,26], only a brief overview is provided below. Because verbatim content is literal but gist content reflects interpretation, research assistants performed verbatim coding and RA patient-coders (who had the experience needed to interpret the information rheumatologists provided) performed gist coding.…”

“…The Verbatim Coding Scheme captured the specific medication risks that the rheumatologist discussed during each visit and, for each risk, whether the following risk dimensions were discussed: probability of occurrence, potential severity/impact, strategies to minimize risk, strategies to monitor risk, what to do if the risk occurs, time course (e.g., when the risk is most likely to occur), whether potential harm would be permanent or temporary, and therapeutic alternatives with different risk profiles [26]. Data were aggregated across risks so that each observation in the analytic dataset corresponded to a specific medication discussed at a specific patient visit.…”