Aspects of patient and clinician language predict adherence to antidepressant medication

Abstract

Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence. Methods: We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of <180 days covered (PDC) (primary outcome), were measured based on pharmacy records. Results: Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: rs <0.27; P >.05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: rs <0.25; P >.05). In an adjusted analysis, empathy (t = 2.3; P = .027) and <2 CT statements (t = 2.3; P = .024) were associated with higher PDC. Conclusions: Clinician empathy, reflections, and MIAs may elicit patient CT, whereas empathy and CT seem to enhance filling an initial prescription and PDC. (J Am Board Fam Med 2013;26:409-420.).