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Provider Views About Responsibility for Medication Adherence and Content of Physician–Older Patient Discussions
Author(s) -
Tarn Derjung M.,
Mattimore Thomas J.,
Bell Douglas S.,
Kravitz Richard L.,
Wenger Neil S.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.03969.x
Subject(s) - medicine , focus group , family medicine , health care , medication adherence , outpatient clinic , nursing , marketing , economics , business , economic growth
Objectives To investigate provider opinions about responsibility for medication adherence and examine physician–patient interactions to illustrate how adherence discussions are initiated. Design Focus group discussions with healthcare providers and audio taped outpatient office visits with a separate group of providers. Setting Focus group participants were recruited from multispecialty practice groups in N ew J ersey and W ashington, D istrict of C olumbia. Outpatient office visits were conducted in primary care offices in N orthern C alifornia. Participants Twenty‐two healthcare providers participated in focus group discussions. One hundred patients aged 65 and older and 28 primary care physicians had their visits audio taped. Measurements Inductive content analysis of focus groups and audio taped encounters. Results Focus group analyses indicated that providers feel responsible for assessing medication adherence during office visits and for addressing mutable factors underlying nonadherence, but they also believed that patients were ultimately responsible for taking medications and voiced reluctance about confronting patients about nonadherence. The 100 patients participating in audio taped encounters were taking a total of 410 medications. Of these, 254 (62%) were discussed in a way that might address adherence; physicians made simple inquiries about current patient medication use for 31.5%, but they made in‐depth inquiries about adherence for only 4.3%. Of 39 identified instances of nonadherence, patients spontaneously disclosed 51%. Conclusion The lack of intrusive questions about medication taking during office visits may reflect poor provider recognition of the questions needed to assess adherence fully. Alternatively, provider beliefs about patient responsibility for adherence may hinder detailed queries. A paradigm of joint provider–patient responsibility may be needed to better guide discussions about medication adherence.