Research Digest

Improving Communications to Improve Adherence

Improving physicians' communication skills can improve detection of nonadherence in glaucoma patients.¹ Researchers used sociolinguistic analysis of videotaped doctor-patient communications before and after an education intervention designed to teach ophthalmologists to employ patient-centered communication techniques to address nonadherence in medication use.

They observed 23 community-based ophthalmologists in 50 patient encounters, and interviewed both doctors and patients afterward. The average number of years in practice was 22.7, and most physicians had known their patients for longer than 5 years.

After the baseline analysis, physicians underwent a day-long educational intervention with a faculty-guided interactive skills training DVD that covered detecting nonadherence, assessing barriers to adherence, and suggested interventions. The DVD presents a four-step patient-centered adherence assessment communication strategy. "It addresses the psychology of patient self-report in such as way as to lower the boundaries to acknowledging nonadherence," says lead investigator Steven R. Hahn, M.D.

At baseline, communication was "physician-centered;" that is, physicians typically asked closed-ended questions about adherence. By contrast, the educational program aimed to teach a communication strategy of "ask-tell-ask": ask an open-ended question, such as, "How do you take your medications?"; next, tell the patient what was correctly known and clarify mistaken beliefs; finally, ask if their attitudes and beliefs changed during the discussion. A follow-up analysis of videotaped encounters with the same 23 ophthalmologists and 50 different glaucoma patients showed that, post-intervention, physicians significantly increased use of the targeted patient-centered communication skills and detected 78% of the patients found to be nonadherent on post-visit interview, compared to 25% in Phase 1.

"What doctors typically do, unless they've learned otherwise, is give patients a data download: ‘You have glaucoma. What glaucoma is, etc.,’ explains Dr. Hahn. "They don't ask patients what they already know or what their concerns are and base their education on that information." OM

1. Hahn SR, Friedman DS, Kotak S. Physician Training in Patient-Centered Communication and Adherence to Treatment Improves Interaction and Assessment of Patients With Glaucoma. American Glaucoma Society meeting, San Diego. March 7, 2009.