Talk to me: Intervention improves docs' communication about meds

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 - Pill Case

Researchers have found that a brief, targeted intervention directed toward physicians positively influences discussions between physicians and patients about new medications. This study was published in the January/February issue of the Annals of Family Medicine.

Between February 2009 and February 2010, Derjung Tarn, MD, PhD, of the University of California at Los Angeles, and colleagues recruited 27 physicians from three primary care practices to participate in the study; about half of the participating physicians in each practice were given a targeted intervention lasting approximately one hour. The intervention was an interactive session that included role play and skills development, and emphasized discussion of five elements when prescribing a new medication to a patient: name of the medication; its purpose; dosing instructions and/or other directions for correct use; duration of use and side effects.

The session also covered common reasons why physicians do not provide patients with this information. The control group received no interventions, and the physicians who participated in the intervention were instructed not to discuss it with others in their practice.

Consecutive patients aged 50 and older were recruited to participate. Eligible patients spoke English, had a new, worsening or uncontrolled problem and agreed to a follow-up visit; a total of 256 patients were enrolled. Participating patients completed pre-visit surveys and post-visit surveys. The participating physicians’ interactions with the participating patients were recorded and if a patient received a new prescription, the verbatim transcript was analyzed by the research team to determine how many of the five critical elements the physician covered during the visit with the patient.

The physicians were graded to assess their Medical Communication Index (MCI) score, in which they received one point for each of the five critical elements; they received one-half point for discussing the number of doses or sprays they were prescribing and one-half point for explaining dosing frequency.

The mean MCI among the physicians who participated in the intervention was 3.95 vs. 2.86 for the control group. The intervention group discussed each of the five elements with more frequency than did the control group physicians. “Compared with the control group physicians, intervention group physicians provided information about the medication name, number of tablets, dosing frequency, duration of use and side effects for at least 20 percent more of their newly prescribed medications,” the authors wrote.

The intervention did not affect patients’ opinions about overall communication with their physicians or their trust in their physicians. But patients of physicians who participated in the intervention reported better communication about medication than did patients of physicians in the control group.

The authors asserted that “though physician communication is only one of many factors influencing patient medication adherence, the physician-patient interaction often serves as a patient’s introduction to a medication, may affect whether a patient decides to fill a medication, and creates the context in which a new medication is experienced." Therefore, they postulated, better initial communication about a new prescription may lead to enhanced medication adherence.  

The authors acknowledged the study had several limitations: the patients were a convenience sample, mostly white with at least some college; the audio recorder may have influenced the physicians to communicate differently than they may have otherwise; and the researchers did not assess communication style or the quality of the information the physician provided.

Information about how the communication influenced the patients’ medication adherence—whether they filled their prescriptions and took the medication as prescribed—was outside the scope of the study. The authors suggested that the clinical impact of communication interventions should be tested.