Communication: Perception and Recall
Provider communication effects medication adherence in hypertensive African Americans

https://doi.org/10.1016/j.pec.2008.09.018Get rights and content

Abstract

Objective

To evaluate the effect of patients’ perceptions of providers’ communication on medication adherence in hypertensive African Americans.

Methods

Cross-sectional study of 439 patients with poorly controlled hypertension followed in community-based healthcare practices in the New York metropolitan area. Patients’ rating of their providers’ communication was assessed with a perceived communication style questionnaire,while medication adherence was assessed with the Morisky self-report measure.

Results

Majority of participants were female, low-income, and had high school level educations, with mean age of 58 years. Fifty-five percent reported being nonadherent with their medications; and 51% rated their provider's communication to be non-collaborative. In multivariate analysis adjusted for patient demographics and covariates (depressive symptoms, provider degree), communication rated as collaborative was associated with better medication adherence (β = −.11, p = .03). Other significant correlates of medication adherence independent of perceived communication were age (β = .13, p = .02) and depressive symptoms (β = −.18, p = .001).

Conclusion

Provider communication rated as more collaborative was associated with better adherence to antihypertensive medications in a sample of low-income hypertensive African-American patients.

Practice implications

The quality of patient–provider communication is a potentially modifiable element of the medical relationship that may affect health outcomes in this high-risk patient population.

Introduction

African Americans have the highest prevalence of hypertension, making it a major contributor to cardiovascular morbidity and mortality in this population [1]. Poor adherence to prescribed antihypertensive medications has been implicated as a major barrier to poor blood pressure control in African Americans [2]. However, potentially modifiable barriers to medication adherence in this patient population, such as patient–provider communication, have not been well studied.

According to the Institute of Medicine report, Unequal Treatment, the perceived quality of interpersonal communication within the patient–provider relationship is a potential mechanism for the worse health outcomes noted in minority populations [3]. Patients’ perception of their providers’ communication, including the ability to listen and show respect during the medical encounter, are important determinants of patient satisfaction and health care utilization [4], [5], [6], [7]. Further, patients who engage in shared decision-making with providers are more likely to be informed about their condition, more likely to be satisfied with the interpersonal and technical aspects of their care, and more likely to adhere to recommended treatment [8], [9], [10]. Minority patients, however, are least likely to engage in a participatory relationship with their providers [11]. Similarly, providers tend to deliver less information and supportive talk to minority patients, as well as those of lower socioeconomic status [12], [13].

Despite the mounting evidence that minority patients receive a lower quality of interpersonal care and, thus, are less satisfied with the relationship they have with their providers [6], [14], few studies have assessed the effect of communication on intermediate clinical outcomes, such as medication adherence, in this patient population [15], [16]. Further, of the studies conducted to date, none have examined the mechanisms through which such effects occur, specifically in a community-based sample of largely low-income, hypertensive African Americans, who experience the highest burden of hypertension-related outcomes of any other racial group. Thus, the objective of this study was to evaluate the effect of patients’ perceptions of their providers’ communication on medication adherence, among hypertensive African Americans followed in community-based primary care practices.

Section snippets

Participants

This study was conducted as part of an ongoing group randomized controlled trial, Counseling African Americans to Control Hypertension (CAATCH), in Community/Migrant Health Centers (C/MHCs). The purpose of CAATCH is to evaluate the effectiveness of a multi-level intervention in improving blood pressure (BP) control among hypertensive African Americans. The present cross-sectional study was designed to assess patients’ perception of their providers’ communication on medication adherence in a

Results

A total of 72 providers who enrolled in the parent trial were included in this cross-sectional study. A majority of the participating providers were female, had a mean age of 45 years, were internists, and on average had practiced 7 years at their respective C/MHC (Table 1). The patient flow in the study is shown in Fig. 1. As shown, 2694 patients were screened, of whom 1593 (59%) did not meet the inclusion criteria. Of the eligible 1101 patients, 564 (51%) were excluded for various reasons

Discussion

Findings from our study indicate that patients’ ratings of their provider's communication perceived as more collaborative was associated with better adherence to prescribed antihypertensive medications in hypertensive African Americans. We also found that younger age and the presence of depressive symptoms was significantly associated with worse medication adherence in this study's patient population, which is consistent with previous studies in hypertensive patients [25], [28], [29], [30]. The

Role of funding source

This study was supported by F31 HL081926-01, R01 HL 078566, and R24 HL 76857 from the National Heart, Lung, and Blood Institute. The funding agency played no role in the design, conduct, or reporting of the study, or in the decision to submit this manuscript for publication.

Conflict of interest

All authors declare that there are no competing or financial relationships that may lead to a conflict of interest.

Acknowledgements

We gratefully acknowledge Andrea Cassells, MPH and Chamanara Khalida, MD for all of their help with data management.

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