Physicians’ Attitudes and Practices Regarding Adherence to Medical Regimens by Patients with Chronic Illness

Abstract

Health professionals often do not detect nonadherence despite substantial adverse impacts on health-care delivery and costs. We sought to determine how physicians assess and manage adherence among patients with chronic illness, and whether approaches to nonadherence differ by level of clinical training or prior training regarding adherence. Two-hundred seventeen pediatricians and internists completed an Internet-based survey. Responses demonstrated that few had previous formal training regarding patient adherence. Physicians’ assessment of nonadherence and knowledge and skills regarding strategies for improving adherence appeared significantly more advanced among physicians with more clinical experience and among those with formal training in adherence assessment and management. Formal educational interventions may improve adherence-related knowledge and skills.

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References

Haynes RB , Sackett DL. Compliance with Therapeutic Regimens. Baltimore, MD: Johns Hopkins University Press; 1976.

Epstein LH , Cluss PA. A behavioral medicine perspective on adherence to long-term medical regimens. J Consult Clin Psychol. 1982;50:950-971.

Rapoff MA. Adherence to pediatric medical regimens. New York, NY: Kluwer Academic/Plenum Publishers; 1999.

Noncompliance with Medications: An Economic Tragedy with Important Implications for Health Care Reform: A Report. Baltimore, MD: The Task Force for Compliance; 1994.

Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

Berg JS , Dischler J , Wagner DJ , et al. Medication compliance: a healthcare problem. Ann Pharmacother. 1993;27: S1-S24.

Steele DJ , Jackson TC , Gutmann MC. Have you been taking your pills? The adherence-monitoring sequence in the medical interview. J Fam Pract. 1990;30:294-299.

Russell ML , Insull W Jr , Probstfield JL. Examination of medical professions for counseling on medication adherence. Am J Med. 1985;78:277-282.

Hanson RW. Physician-patient communication and compliance. In: Gerber KE , Nehemkis AM , eds. Compliance: The Dilemma of the Chronically Ill. New York, NY: Springer Publishing; 1986.

10.

Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.

11.

Casebeer LL , Klapow JC , Centor RM , et al. An intervention to increase physicians' use of adherence-enhancing strategies in managing hypercholesterolemic patients. Acad Med. 1999;74:1334-1339.

12.

Cabana MD , Rand C , Slish K , et al. Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking. Pediatrics. 2004;113:78-81.

13.

Bandura A. Self-efficacy: the exercise of control. New York, NY: W.H. Freeman; 1997.

14.

Gillum RF , Barsky AJ. Diagnosis and management of patient noncompliance.JAMA. 1974;228:1563-1567.

15.

Hingson RW. The physician’s problems in identifying potentially non-xcompliant patients. In: Barofsky I , ed. Medication Compliance: A Behavioral Management Approach. Thorofare, NJ: C.B. Slack; 1977.

16.

Lerner BH , Gulick RM , Dubler NN. Rethinking nonadherence: historical perspectives on triple-drug therapy for HIV disease. Ann Intern Med. 1998;129:573-578.

17.

Murphy J , Coster G. Issues in patient compliance. Drugs. 1997;54:797-800.

18.

Management of patient compliance in the treatment of hypertension . Report of the NHLBI Working Group. Hypertension. 1982;4:415-423.