What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice

Abstract

Dulmen, S. van, Bijnen, E. van. What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice. ABSTRACT Many patients do not use their medication as prescribed. This non-adherence is a well-known and resistant problem, requiring good physician-patient communication. However, when it comes to talking about (non-)adherence, both physician and patient refrain from putting the topic high on the agenda. The reasons for doing so are far from clear. We therefore conducted a qualitative, video-facilitated study to find out why physicians communicate with their patients about medication use and adherence in the way they do. Using reflective practice, 20 general practitioners (GPs) independently watched video-recordings of their own visits and were asked to reflect on 'critical incidents' operationalised as segments of a visit which ask for a discussion of proper medication use or adherence. Determinants of such a discussion appeared to be the type of medication, patient and GP characteristics, and particular elements of the medical visit and of the broader practice organisation in which the visit took place. Determinants mentioned most often were a lack of time, other priorities, being acquainted with the patient, reluctance to disclose too much information out of a risk of reinforcing side-effects, and relying on the patient for returning to the GP office when existing complaints persist. Apparently, many GPs are biased when it comes to discussing proper medication use and preventing non-adherence. These results provide input for developing communication interventions and guidelines for discussing medication use with patients more elaborately. Reflective practice appeared to be a valuable and appreciated tool to investigate determinants of physician behaviour. INTRODUCTION Non-adherence to prescribed medication is a serious and hard to solve problem. Studies indicate that in developed countries, non-adherence averages from 25% up to 50% in patients with a chronic disease [1,2]. This is problematic, as it implies that many chronically ill patients, whose numbers increase rapidly [1], do not benefit from medical treatment [3], and scarce health care resources are partly wasted. Although successful adherence interventions do exist [4-8], half of interventions seem to fail [9]. There are multiple determinants of patient (non)adherence. Psychological traits, such as beliefs in medication and personal effectivity, have been found to increase adherence, whereas treatment factors such as the frequency and the timing of medication intake and experienced side effects decrease the level of adherence by the patient [1]. Apart from such personality and medication related determinants, prescriber characteristics seem to affect adherence rates as well resulting in much variation in the patient adherence