When physicians prescribe a new medication, there are many instances when basic information about the drug is not discussed with patients. Guidelines recommend that older adults be educated about the reason physicians prescribe medications, how to take them, and their potential side effects. “It has been postulated that better patient knowledge about medications may lead to better adherence,” says Derjung M. Tarn, MD, PhD. It has been reported that patients who have better and more discussions with their doctors about prescription medications are more adherent to them than those receiving less information.
Many interventions have been launched in clinical studies to improve patient education and counseling about medications, but few have targeted the content of physician communication. “Physician-targeted interventions vary, but research shows that the information doctors provide to patients tends to be lacking in many cases,” Dr. Tarn explains. “They rarely address the cost of medications and oftentimes don’t adequately monitor adherence.” Greater exploration is needed into the information exchange during conversations with patients after prescribing medications.
Prescription Medication Intervention
In a study published in the Annals of Family Medicine, Dr. Tarn and colleagues tested an intervention that involved training physicians to discuss five basic facts about a prescribed medication with patients: 1) the medication’s name, 2) its purpose, 3) directions for its use, 4) duration of use, and 5) potential side effects. How well physicians communicated these facts to patients was measured using the Medication Communication Index (MCI), a previously developed, 5-point index in which 1 point is given for discussion about each of five topics relating to a new prescription. Training consisted of a 1-hour interactive educational session that encouraged doctors to communicate the five basic facts. Participating patients also received a flier listing the five facts.
“Physicians who completed the training demonstrated significant improvements in how they communicated prescription medication information,” Dr. Tarn says. When compared with a control group that received no training, the intervention group physicians discussed at least one additional topic out of the five. The mean MCI for physicians in the intervention group was 3.95 (out of 5.00), compared with 2.86 for those physicians who did not receive the training intervention (Figure 1). When compared with the control group, physicians in the intervention group provided information about the five MCI components for at least 20% more of their newly prescribed medications. Counseling about three of the five MCI components occurred more often in the intervention group.
“Physician-targeted interventions vary, but research shows that the information doctors provide to patients tends to be lacking in many cases.”
Patient ratings of new medication information transfer were also higher for the intervention group. Higher MCI scores correlated with better patient ratings about information on new prescriptions. “It was a pleasant surprise to see that our relatively simple intervention was effective in improving the content of discussions for patients,” adds Dr. Tarn.
Fostering Greater Patient Communication on Medications
Another important finding from the study by Dr. Tarn and colleagues was that their training intervention fostered more in-depth communication about the medications the physicians prescribed (Figure 2). “In some cases,” Dr. Tarn says, “physicians who were trained in the intervention went beyond the basics and discussed other pertinent facts about medications that were important for patients to know.” Higher MCI scores were associated with more reports of communication about topics not directly included in the intervention. For example, the intervention encouraged physicians to discuss potential medication side effects with patients, but patients also reported better communication about risks of experiencing side effects and what to do if they occurred.
More to Come to Enhance Medication Adherence
“Our efforts to enhance medication adherence are unimportant if the original prescription is never filled,” says Dr. Tarn. “While our analysis did not evaluate whether better communication affects medication adherence, it did suggest that brief, practical strategies may help improve physician communication about newly prescribed medications in ways that truly affect patients.” She notes that it is possible new prescription discussions that include more basic elements of medication communication are more complete in other ways, but this requires further exploration.
More research is needed on the relationship between physician communication and medication adherence, according to Dr. Tarn. “We need to further test our intervention for its clinical impact. Physician-targeted educational sessions can help but will most likely need to be tailored based on the needs of each practice setting. As we gain a clearer picture of the impact of improved communication, it’s hoped that this will translate into better clinical outcomes.”
Readings & Resources (click to view)
Tarn DM, Paterniti DA, Orosz DK, et al. Intervention to enhance communication about newly prescribed medications. Ann Fam Med. 2013;11:28-36. Available at: http://www.annfammed.org/content/11/1/28.full.pdf+html.
Tarn DM, Heritage J, Paterniti DA, et al. Physician communication when prescribing new medications. Arch Intern Med. 2006;166:1855-1862.
Fischer MA, Stedman MR, Lii J, et al. Primary medication nonadherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25:284-290.
Tarn DM, Heritage J, Paterniti DA, et al. Prescribing new medications: a taxonomy of physician-patient communication. Commun Med. 2008;5:195-208.
Rao JK, Anderson LA, Inui TS, Frankel RM. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care. 2007;45:340-349.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497.
Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect. 2004;7:235-245.