Ask us if we are more likely to use a medication as directed if our doctors explain why a specific drug might be helpful, how to take it so that it is most effective and what its possible side effects are and then discuss whether we think we are willing and able to take it.
An article in the June issue of Archives of Internal Medicine validates our response: Patients of physicians who score higher on tests of medical management and communication ability are more likely to be taking hypertension medication after six months than those whose physicians score lower.
This is a study about people working with their doctors to find a hypertension medication routine that works and sticking to it.
Adherence (or 'persistence' as the researchers call it) to hypertension medication recommendations is a real problem. It's tough to take a drug that has side effects for a disease that has no symptoms. In general, less than 75 percent of people who are prescribed hypertension medication are still taking it after six months. This study found that patients of physicians with better medical management (particularly clinical decision-making) and communication (particularly data-collection skills) abilities were more likely to be engaged in treating their hypertension.
The researchers also found that specific aspects of the treatment itself influenced whether or not people stuck it out. For example, people whose prescription was changed soon after starting were more likely to continue, as were those who had more frequent and earlier follow-up visits. Physicians with higher scores on the relevant tests were more likely to change their patients' medications during the first two weeks and more likely to have follow-up visits with them during the first two months.
The study is remarkable for a couple reasons. First, it is huge: over 13,000 people with hypertension were followed. Studies that look at behavior ours or our providers tend to be small. The findings from such a large study can't be easily dismissed.
Second, it is a population-based study: no intervention was implemented and tested. Rather, the researchers looked at the effect of independently assessed characteristics of doctors on the medication use of their patients, measured as part of an examination that doctors must take in order to be licensed to practice medicine in Canada. The effects of these physician characteristics on patients behavior over the first six months of their treatment were measured by examining prescription and medical services databases. Thus, the likelihood of bias influencing these measures is extremely small.
This study provides robust support for the role of providers in enabling us to more fully benefit from our care. It reinforces the principles of some of the models of care delivery currently being implemented. For example, the proactive, planned approach of the Chronic Care Model. It has implications for training, certifying and licensing providers in the United States. And it is too big to ignore.
This is a Canadian study. Much is made in political circles of the differences between health care in Canada and America. In this case, however, the crucial difference lies in the Canadian's government support of databases that allow for the exploration of this kind of health care delivery question and not in the finding that we Canadian and American alike make better use of the care available to us when we work together with our providers to solve our health problems.
How will this data shape efforts to improve health care quality and support us in caring effectively for ourselves?