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Sep 23

jch_coverWe know that many patients never fill the prescriptions given to them by their physician, and fewer still are fully compliant. But what patient beliefs are major factors in adherence with drug therapy?

Kathleen Mazor, Susan Billings-Gagliardi, and Melissa Fischer tackled this question in the recent Journal of Communication in Healthcare article “Initial Acceptance of Treatment with Antihypertensive Medication; the Importance of Communication, Trust, and Beliefs.”

Although it seems obvious, it’s important to remember that for drug therapy to actually occur, a patient must accept the recommendation to start the medication.

The major finding in the study was that there are four major beliefs that impact acceptance of drug treatment:

1) trust in the physician

2) the perception that the physician communicated well

3) the belief that medication is effective

4) the belief that doctors don’t prescribe unsafe medications

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Mazor’s study is not without its flaws. Data was gathered by random subjects looking at paper material, rather than an analysis of actual patient opinions of their physician and actual behavior regarding treatment initiation. Mazor herself addresses these limitations, stating that, “While it may be a shortcoming, this methodology is an efficient way to systematically test hypotheses about factors that may influence patients’ decision-making about medications.”

As I dove deeper into this issue I stumbled upon the Trust in Physician Scale which is an 11 item instrument that seems to have decent validity. I’ll have to dig deeper but to see if others have already done the studies linking trust to other “empowered patient” issues. One of the demographic factors this scale uncovered is that people over 55 are far more likely to trust their doctor than those who are younger. As the younger, more empowered (and perhaps more cynical) generation matures, the trust and therefore adherence issue will just become worst.

[What are the drivers of TRUST?]

This leads to the real issue I think which is, How can trust be increased? What are the drivers of trust?

And while physicians and other healthcare providers should certainly be interested in this question, the providers of the medication certainly have a stake in the game too. Perhaps pharma reps shouldn’t just detail physicians on the science of the medicine, but offer suggestions on how best to communicate value to appropriate patients?

What are your thoughts on increasing patients’ trust in their physicians?

  • pm

    This is not simply the key issue, this is what patients and patient organisations all over the world advocate and ask for.
    Lea, you shouldn't be stunned that patients don't trust their doctors, since doctors have not been taught to how to communicate in general and particularly with patients, since their profession is about communicating findings, diagnoses, therapies, outcomes. I am not talking only about middle-age health professionals, I am also talking about the younger generations. Even now, the majority of medicine schools around the world, despite all the hype about communication, do not include patient-doctor communication, patient rights, communication of serious disease diagnosis, and similar subjects in their core subjects syllabus.
    They overlook the holistic approach to medicine that Hippocrates taught. Modern medicine approaches the human body as a complex system, with a great number of sub-systems and a multitude of processes, and medical doctors as specialised engineers of specific sub-systems.
    How can I trust a doctor who is interested only on how a sub system in my body functions and not IN ME, who stands in front of him, e.g. only if my intestine works as it should and he is not interested in eventual other health problems, I may face or in my psycho-social situation, that may affect my ability to digest and metabolize food, i.e. the proper function of my intestine.
    Yes, even for oncology patients appointments in public hospitals are fixed every 10 minutes, in private hospitals 15-20 minutes. In the ten minutes, the oncologist has to hand-write instructions, drug prescriptions, tests prescriptions, look at and evaluate previous tests, examine patient, communicate diagnosis and instructions. The doctor struggles to make do with the hospital and social insurance bureaucracy and the patient with his fears of the unknown, the lack of understanding of what the doctor's words mean for him, his doubts about the best course to follow.
    The above conditions do not foster trust, because the patient cannot trust a doctor, even good willing, who has to satisfy bureaucracy, do at least the minimum for the patient and usher him to the exit for the next patient, so that he can finish his day on time.
    The doctors rarely really listen, they tell you: let me see the tests and then, they proceed to drug prescription, often without clinical exam, stating that tests are tell tale or they ask you: do you want to have a clinical exam? But Doc, the patient has come to your practice/hospital, exactly for this and for being heard, for God's sake, after what, you may look at the tests....
    As for the role of the pharma industry in drug adherence, this is another business story. Every forgotten pill is money lost for the pharma industry. Lea does not mention that compliance is so important for the pharma industry, that they offer specific training to their staff to this purpose, they support events of patients organisations indirectly strengthening compliance, they talk about awareness and need to follow therapy and they mean compliance, while ate the same time, the patient audience understands and thinks they talk about adherence. Two completely different concepts with different meanings and consequences for patients and the pharma industry.
    Well, I could continue and write a lot about my own and other patients experiences in doctor-patient communication. Maybe, we may start a constructive exchange of views on this topic here, since the question is how to improve the free communication between doctor and patient.

  • This is a key issue these days. I'm really stunned when I hear from focus groups that they really don't trust their doctors. I hear that more than I'd expect. I think a lot of it has to do with the way medicine works these days. Too many people don't really have a personal relationship with their doctor, and get maybe 10 minutes with them during an appointment. Too often patients don't feel like the doctors are listening.

    I think you also hit it right on the head about the role of the pharma reps. This needs to be reinvented. There is so little time for MD/rep visits we need to start thinking about how to get the most value for both out of the visit. Do MDs really need reps to detail them on the science? Can't we point them to the website for that? Can the reps help facilitate the doctor patient dialogue by letting them know what's being asked elsewhere?

    Seems like my common thread is learning how to listen again.

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