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Conversation Increases Blood Pressure Medication Adherence for Some Low-income Patients

Physicians uncertain how to help low-income patients follow their blood pressure medication regimens are advised to take this approach: Just discuss it with them.

A study published in the journal Circulation: Quality and Outcomes said failure by the healthcare provider to converse with patients or ask them about issues such as employment, housing, and partner relationships decreased the chances they would take their blood pressure drugs as directed.

How much difference did that make?

A lot, according to NYU School of Medicine researchers and colleagues. They found that those patients were three times less likely to take their medications when the prescriber did not ask open-ended questions, check their understanding of instructions, or engage in a collaborative communication style. Medication adherence was six times less likely when patients weren’t questioned about social issues during the appointment.

"When healthcare providers ask patients about life challenges or take the time to check their patient's understanding of instructions, it signals that their healthcare provider genuinely cares about them and provides the motivation and confidence to manage their health issues on their own," explained lead author Antoinette Schoenthaler, EdD, an associate professor of medicine at NYU School of Medicine in New York City.

Researchers audiotaped one office visit for each of 92 patients who saw 27 providers over a three-month period from three practices that serve a multiethnic, low-income population in New York City. Whether patients took their medications was determined by a device that recorded the time and date they opened their pill bottles.

Most of the patients were black, unemployed, and reported some college education. Fifty-eight percent were women who had been seeing the same healthcare provider for at least a year. Most of the providers were white (56%) and female (67%) and had been in practice for an average of 5.8 years.

With 58% of patients exhibiting poor adherence to prescribed antihypertensive medications, the researchers identified three categories of patient-provider communication linked to lower likelihood of following drug regimens: lower patient centeredness, less discussion about patients’ sociodemographic circumstances, and lack of discussion about their antihypertensive medications. Researchers also found the effect of having less discussion about patients’ sociodemographic circumstances on medication adherence was increased in black patients.

"Healthcare providers should talk to patients about the things that get in the way of taking their medication, such as relationship status, employment, and housing,” Schoenthaler advised. “Unemployment, for example, affects whether patients can afford medication, which is a primary risk factor for non-adherence. If these issues go undiscussed, healthcare providers may never figure out why patients are not taking their medications.”