Physician Communication When Prescribing New Medications

Tarn, Derjung M.; Paterniti, Debora A.; Hays, Ron D.; Kravitz, Richard L.; Wenger, Neil S.

doi:10.1001/archinte.166.17.1855

Cited by 340 publications

(254 citation statements)

References 40 publications

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“…al identifiy additional patient and provider level factors predictive of nonadherence to antipsychotic medication among persons with schizophrenia including poor insight, negative attitude or subjective response toward medication, substance abuse, shorter illness duration, and inadequate discharge planning or aftercare environment [14]. Potentially related to language proficiency, a patient’s knowledge regarding benefits of the medication, side effects, and frequency, duration, and dosing may be affected by providers’ explanations for new medications [15]. Similarly, a client’s level of health literacy may affect the processing of information provided during clinical visits [16].…”

Section: Introductionmentioning

confidence: 99%

Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Gilmer

Ojeda²,

Barrio³

et al. 2009

Psychiatric Services

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OBJECTIVES We examined the relationship between preferred English, Spanish, or an Asian language for mental health services and adherence to treatment with antipsychotic medication and Medi-Cal beneficiaries with schizophrenia in San Diego, California. METHODS Data included 31,560 person-years from 1999–2004. Pharmacy records were analyzed to assess adherence to antipsychotic medication, based on the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<0.5), partially adherent (0.5<=MPR<0.8), adherent (0.8<=MPR<=1.1), or as an excess filler (MPR>1.1). Regression models were used to examine adherence, hospitalization, and costs by race/ethnicity and language status. RESULTS Limited English proficient Latinos were more likely to be adherent to antipsychotic medications than English proficient Latinos (40.8% vs. 35.9%, P<0.001). Limited English proficient Latinos were less likely to be excess fillers than English proficient Latinos (15.1% vs. 20.4%, P<0.001). Limited English proficient Asians were less likely to be adherent than English proficient Asians (40.1% vs. 45.1%, P=0.034). Compared to English proficient Asians, limited English proficient Asians were more likely to be nonadherent (28.7% vs. 22.0%, P<0.001) and less likely to be excess fillers (12.5% vs. 17.4%, P=0.004). Controlling for adherence and comorbidities, limited English proficient clients had lower rates of hospitalization and health care costs than English proficient and white clients. CONCLUSIONS Adherence to antipsychotic medications varies among and within ethnic groups by English proficiency. Policies supporting the training of bilingual and multicultural ethnic minority providers, and interventions that capitalize on existing social support networks, may improve adherence to treatment among linguistically diverse populations.

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Section: Introductionmentioning

confidence: 99%

Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Gilmer

Ojeda²,

Barrio³

et al. 2009

Psychiatric Services

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“…For example, Tarn et al showed that family and internal medicine physicians mention adverse effects to only 33% of their patients, with a mean medication communication index (MCI) of 3.1/5, indicating that they communicate only 62% of necessary elements of new medications to their patients. 12 Ha et al presents numerous barriers to good communication in the doctor-patient relationship such as deteriorating physician-communication skills, nondisclosure of information such as adverse drug reactions and complications from procedures, doctor-avoidance behavior surrounding difficult topics such as uncertainties in diagnosis and treatment failures, discouragement of collaboration between physicians and patients to create optimal care plans that suit both parties, and resistance by patients to engage in the medical decisionmaking process. 14…”

Section: Misperceptions and Assumptionsmentioning

confidence: 99%

“…In addition to being wasteful and burdening the system with unendurable costs, overuse of medical services comes with its own potential for negative effects on patienthealth such as false-positive tests, procedure-related complications, adverse medication effects, and drugdrug interactions. 5,8,10,12 …”

Section: Viewpoint Room For Improvementmentioning

confidence: 99%

“…Another potentially invaluable strategy to improving our system's overuse problem is research focusing on dedicating time in the encounter to reviewing risks, benefits, and alternatives of every new procedure, medication, and test ordered. 5,12,15 Again, one might claim that this additional time might be burdensome to clinicians, but a rebuttal to this argument could be that these discussions will save time in future appointments. In addition, the length of a physician's visit has been shown to be negatively associated with a physician's malpractice claim status and overprescribing practices and positively associated with patient and physician satisfaction.…”

Section: Possible Solutionsmentioning

confidence: 99%

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Another Pill, Another Test, and Another Procedure: One Resident's Reflection on Healthcare Cost Containment

Chertoff

2015

Glob Adv Health Med

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In the United States, healthcare expenditures have continued to rise at alarming rates despite numerous strategies to contain costs. One area of focus that is underappreciated is doctor-patient communication about expectations of treatment. Studies have shown that clinicians’ misperceptions of assumptions about patients’ expectations are an essential component to our nation's healthcare overuse problem. Strategies to address these misperceptions and assumptions as a method of reducing costs and providing higher-quality care to our patients are warranted.

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“…[81][82][83] The availability of liquid medications in different concentrations, 84 instructions given using different units of measurement (eg, mL, teaspoon, tablespoon), 85 and the wide variety of dosing instruments 86-88 also contribute to parent confusion with provider instructions. 86,87,89 The literacy demands placed on patients and caregivers as they seek to follow medication instructions are formidable.…”

Section: Patient Safety and Medication Errorsmentioning

confidence: 99%

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

Rothman

Yin²,

Mulvaney³

et al. 2009

Pediatrics

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Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorable factor for improving quality of care. Studies of adults have documented that lower health literacy is independently associated with poorer understanding of prescriptions and other medical information and worse chronic disease knowledge, self-management behaviors, and clinical outcomes. There is also growing evidence to suggest that health literacy is important in pediatric safety and chronic illness care. Adult studies have suggested that addressing literacy can lead to improved patient knowledge, behaviors, and outcomes. Early studies in the field of pediatrics have shown similar promise. There are significant opportunities to evaluate and demonstrate the importance of health literacy in improving pediatric quality of care. Efforts to address health literacy should be made to apply the 6 Institute of Medicine aims for quality-care that is safe, effective, patient centered, timely, efficient, and equitable. Efforts should also be made to consider the distinct nature of pediatric care and address the "4 D's" unique to child health: the developmental change of children over time; dependency on parents or adults; differential epidemiology of child health; and the different demographic patterns of children and their families. The views presented in this article are those of the authors, not the organizations with which they are affiliated.www.pediatrics.org/cgi

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Physician Communication When Prescribing New Medications

Abstract: When initiating new medications, physicians often fail to communicate critical elements of medication use. This might contribute to misunderstandings about medication directions or necessity and, in turn, lead to patient failure to take medications as directed.

Cited by 340 publications

References 40 publications

Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Another Pill, Another Test, and Another Procedure: One Resident's Reflection on Healthcare Cost Containment

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

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