Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors

Abstract

CONTEXT: Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006. OBJECTIVE:To determine the prevalence of physicianpatient dialogue about medication cost and medication adherence among elderly adults nationwide. DESIGN:Cross-sectional survey.PARTICIPANTS: National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older. MAIN OUTCOME MEASURES:Rates of physicianpatient dialogue about nonadherence and cost-related medication switching.RESULTS: Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28-5.93, P<.001). CONCLUSIONS:We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters.

The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

“…That is, more than half of all people with COPD who have been referred to a pulmonary rehabilitation programme have at least one other chronic condition [30] and, therefore, medication burden in this group is likely to be high. Among elderly adults who have been prescribed multiple medications, nonadherence to pharmacotherapy regimens is problematic [31], which, in turn, increases the risk of hospitalisation and mortality [32]. Thus pulmonary rehabilitation offers the opportunity to review medication use and implement strategies to optimise adherence.…”

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

“…[1][2][3][4] Those with limited literacy skills and English proficiency (LEP) are disproportionately at risk. [2][3][4][5][6][7][8][9] The manner in which physicians convey prescription instructions and pharmacy labeling practices has consequently been scrutinized as possible root causes of the confusion. [10][11][12][13][14] This body of research has now been summarized at great length in numerous seminal reports, all recognizing the urgent need to improve written medication instructions and prescription labeling, both to promote patient safety and to improve adherence.…”

Promoting Interprofessional Collaboration: Pharmacy Students Teaching Current and Future Prescribers About Medicare Part D

“…[21][22][23] Yet, in 1 study of Part D beneficiaries with diabetes, less than one-half of patients discussed drug costs with their physicians. 24 Another study found that 40% of physicians reported that, at least once in the previous 30 days, they had not discussed cost with their patients but wished they had.…”