Non-adherence to medication and doctor-patient relationship: Evidence from a European survey.
Learn about the cause and effect of patient non-adherence and Accolade's approach to Does she have concerns about potential side effects from the medications? nature of the doctor/patient relationship may perpetuate non- adherence. retrieved from knifedirectory.info PMC/; Brody. Studies on the determinants of non-adherence to medication have put emphasis in understanding the role of the doctor–patient relationship in individuals'. Conclusions These findings suggest that a trusting physician relationship may cost pressures by nonadherence, although this relationship has not been documented. Understanding patients' cost-related medication adherence behaviors in the In addition to the provision of concrete advice for coping with medication.
Patients' satisfaction resulting from communicating with the physicians is a key factor in predicting patients' treatment process and outcomes  and can influence disease control and treatment because more satisfied patients are more prone to follow the physicians' instructions. Several studies have mentioned the importance of patients' satisfaction followed by communicating with physicians to consider medication adherence;  however, to the best of our knowledge, rarely have the aspects of this relationship been investigated thus far.
Accordingly, the present study was aimed at examining the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Multistage sampling technique was carried out.
First, a list of all health-care centers in Isfahan was provided, from which two centers were randomly selected.
Second, a list of eligible patients having the inclusion criteria was also considered, and the samples were recruited from each of the two health care centers by simple random sampling. The inclusion criteria of the study were as follows: Instrument to collect data Patient's satisfaction questionnaire 24 items was employed to explore their satisfaction with having a relationship with physicians.
This questionnaire had 5 subscales, including satisfaction with building the relationship 7 itemssatisfaction with gathering the information about disease and treatment 4 itemssatisfaction with empathy caused by communicating with physicians 5 itemssatisfaction with perception of respect 4 itemsand satisfaction with shared decision-making 4 items. All items were scored based on 5-point Likert scale ranging from 1 to 5, including completely agree, agree, no comment, disagree, and completely disagree.
The validity and reliability of the current questionnaire have been investigated and confirmed by numerous studies. Furthermore, the content and face validity of the questionnaire were evaluated and approved by the panel of experts. To evaluate the medication adherence, several instruments have extensively been employed. However, none of them has been known as a gold standard.
[Full text] Patient–doctor relationship and adherence to capecitabine in out | PPA
The patients were asked to participate in the survey, and the disinclined participants were replaced with the new ones. Two instruments patients' satisfaction derived from the relationship with physicians and MMAS were simultaneously completed in the self-reported form. After that the questionnaires were completed, all of them were reviewed by the researchers. Such confounding variables as physicians' gender, disease duration, and patients' age, gender, and education level were considered in the logistic analysis, and the adjusted model was also reported.
We applied simple random sampling to control the sampling bias and the trained data collectors to control the interviewer's bias. And then why did you choose this one? Why do you think this will work better for me at this time? All wanted extensive information about side effects.
Although patients agreed on content, they differed as to how that content should be presented. Some wanted a frequently asked questions list that described the benefits and risks of various antihypertensive medications. Still others wanted to track their blood pressure over time. Discussion We held four focus groups with 26 patients who failed to pick up a first prescription for a new antihypertensive medication.
Among these patients with incomplete PMA, distrust and anger regarding the hypertension diagnosis and the need for antihypertensive medications were common. Other PMA barriers included cost, misperceptions about generic medications, fear of side effects and beliefs that not more than one antihypertensive medication was needed. Patients longed to be included more actively in discussions with their providers about the initiation of hypertension treatments and suggested approaches to shared decision making and patient-oriented materials that would make PMA more likely.
Our qualitative results are consistent with these results, because they show that missed opportunities for collaborative discussions lead to incomplete PMA for antihypertensive medications.
Efforts to improve PMA should therefore involve patients in the initial prescribing decisions, offering patients opportunities to communicate their preferences [ 113233 ]. Unfortunately, training providers to enhance communication can be lengthy and resource intensive, and it is not widely available [ 34 ].
The Cause and Effect of Patient Non-Adherence
How else can a collaborative relationship be introduced and strengthened, even as most providers and patients do not receive communication skills training? A promising approach is the use of decision support tools, which provide structure to the decision-making process, breaking it down into smaller, manageable steps [ 14 ] and require no formal training to use.
Patients in our study endorsed the use of decision support tools, suggesting content such as sample dialog and a frequently asked questions list to get the much-needed information. Although patients in our study disagreed on how content should be presented, a flexible decision support tool might include multiple formats to communicate information.
Non-adherence to medication and doctor-patient relationship: Evidence from a European survey.
Together, patients and providers can then choose the optimal format or focus on the content that is most relevant to them. Other approaches that enhance communication and foster collaborative care may also hold promise; future research should focus on identifying and testing such approaches in real-world clinical settings [ 37 ] and evaluate the extent to which decision support might be integrated[ 38 ].
To our knowledge, our study is the first to examine the knowledge, attitudes and beliefs among patients, who were identified as primary non-adherent via their retail pharmacy claims. SPSS version 24 was used for data analysis.
For categorical parameters, absolute and relative frequencies were reported. Multivariate logistic regression models were used to identify the independent factors associated with adherence to capecitabine, with adjustments for age, gender and time since diagnosis.
Results Sociodemographics and clinical data Sixty-four patients completely filled in their questionnaires. Table 1 also presents relevant clinical data for the sample population. Participants were mostly in their second year from cancer diagnosis and in their first year of capecitabine treatment. Figure 1 presents the extent to which participants declared to feel troubled by the side effects most frequently reported.
N neg, no regional lymph node metastases; T1, tumor invades submucosa; N pos, metastasis to regional lymph nodes; T2, tumor invades muscularis propria; T3, tumor invades through the muscularis propria into the pericolorectal tissues; M neg, no distant metastasis; M pos, metastasis to distant organs; T4, tumor penetrates visceral peritoneum or invades to other organs or structures; TX, primary tumor cannot be assessed; Cap, capecitabine.
Figure 1 Perceived burden of side effects on a visual analog scale VAS, 0— Adherence Thirteen participants reported non-adherence, and 2 of them reported multiple methods of deviation. Participants reporting non-adherent behavior and those reporting no deviation did not differ significantly in demographic or clinical characteristics.
The necessity—concerns differential yielded negative results for 13 participants, indicating that concerns regarding oral anticancer therapy outweighed necessity beliefs.
The strongest concerns referred to long term effects of capecitabine intake Figures S2 and S3. Satisfaction with information about medicines Figure 2 demonstrates the distribution of responses of the SIMS. Eleven participants reported complete satisfaction with the information provided about capecitabine therapy. The median of the subscale on potential problems of medication was 5 IQR 4—7. Potential predictors of outcome measures Sociodemographic variables, clinical variables including side effects and adherence did not correlate significantly Tables 2 and 3.
Furthermore, there were no significant correlations between the PDRQ-9 single item score and adherence. These results illustrate that patients who were more satisfied with the patient—doctor relationship were generally more satisfied with the information received about their medicine.
Those patients also reported greater satisfaction with the received information about action, usage and potential problems of their medication. Two logistic regression models were investigated, both with adherence as dependent variable. There were no confounding factors adjusted for as we found no significant correlations between sociodemographic and medical variables with adherence in our sample.
The requirements of logistic regression no multicollinearity, no outliers, log linearity were checked with appropriate methods and were met in both models.
Table 4 Logistic regression model on adherence with sum scores as predictors. Table 5 Logistic regression model on adherence with subscores as predictors. Discussion We initiated a survey on the associations between the patient—doctor relationship and beliefs or satisfaction with information about capecitabine in a sample of outpatients treated with oral capecitabine in the clinical setting of a German Comprehensive Cancer Center.
Sixty-four percent of patients received capecitabine as a monotherapy. The mean time since tumor diagnosis and start of capecitabine therapy was 19 and 7 months, respectively. Hand-foot syndrome followed by fatigue was reported by most participants to be troubling, which is in line with other studies.
The levels of satisfaction regarding the total score as well as single items are in fact higher than in a representative German survey focusing on the relationship with the family physician.