Study finds cardiologists are unaware of patient nonadherence to medications

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More than 60 percent of patients said they rarely or never discussed their adherence to medications with their cardiologists, according to a survey-based study conducted at four cardiology practices in and around Chicago.

Further, two-thirds of physicians said they were not aware of how often their patients miss a medication dose, although all physicians acknowledged it was important to discuss medication adherence with their patients.

Rosemary Hines and Neil J. Stone, MD, of Northwestern University, published their findings online in  JAMA Cardiology on May 11.

In this study, the researchers called 21 cardiologists at two academic and two community-based cardiology practices in the Chicago metropolitan and suburban areas from June 2 to July 22, 2015. They told physicians the goal of the study was “to understand an important aspect of patient-physician communication,” but they did not mention specific information about the study.

The researchers also visited physicians’ practices and had 66 patients complete a short, orally administered survey. Patients were at least 18 years old and were taking a cardioprotective medication.

The patient and physician questionnaires were based on the 8-item Morisky Medication Adherence Scale (MMAS-8).

Of the patients, 61 percent said they rarely or never discussed their medication adherence with their physicians. Of those patients, 45 percent said they sometimes or usually forgot to take their medications and 10 percent said they had missed one or more doses of medication in the past two weeks.

Based on the MMAS-8, 12 percent of patients had poor adherence and 55 percent had moderate adherence. Of the eight patients with poor adherence, only one of their physicians identified them as being poorly adherent.

Further, 67 percent of physicians disagreed or strongly disagreed with the following statement: “I am aware of how often my patient misses a dose of medication.” However, each of the 21 physicians agreed with the following statement: “It is important for me to discuss medication adherence with my patient.”

In addition, 38 percent of physicians said they wanted to discuss adherence with their patients but decided not to broach the subject. Of those eight physicians, five said time was their greatest barrier to discussing adherence and three said they had to address more important issues with their patients.

The study had a few limitations, according to the researchers, including its small sample size and focus on only one metropolitan area. Thus, they noted that the results may not be generalizable to other patient populations.

They also mentioned that patients and physicians self-reported their answers, so the results could be subject to recall bias and socially desirable response bias. In addition, they said future studies should evaluate comorbidities such as depression, a more diverse patient population and interviews with physicians other than cardiologists.

“Through a novel approach that involves interviewing both patients and physicians in an outpatient setting, our study corroborates prior data indicating poor patient adherence to cardiovascular medication,” the researchers wrote. “An important finding in the study is that cardiologists appear to be less aware than they know about which of their patients are nonadherent. A single direct question posed by physicians to patients, such as, “How many of your heart drugs have you missed in the last 30 days?” could help resolve the apparent lack of awareness by some physicians about some patients’ poor adherence to medication, with important implications for improved cardiovascular care.”