Applying the resources and supports in self-management framework to examine ophthalmologist-patient communication and glaucoma medication adherence

Little is known about how ophthalmologist-patient communication over time is associated with glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to glaucoma medications measured electronically over an 8-month period. In this longitudinal prospective cohort study, the main variables studied were ophthalmologist communication-individualized assessment, collaborative goal setting and skills enhancement. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited from six ophthalmology clinics. Patients' baseline and next follow-up visits were videotape-recorded. Patients were interviewed after their visits. Patients used medication event monitoring systems (MEMS) for 8 months after enrollment into the study, and adherence was measured electronically using MEMS for 240 days after their visits. Two hundred and seventy-nine patients participated. Patient race and regimen complexity were negatively associated with glaucoma medication adherence over an 8-month period. Provider communication behaviors, including providing education and positive reinforcement, can improve patient adherence to glaucoma medications over an 8-month period.

Physician-patient communication about over-the-counter medications

The purpose of this study was to describe physician-patient communication about over-the-counter medications using a data set comprised of audio-tapes and transcripts of 414 primary care medical visits. The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center. Twenty-seven resident physicians and 414 of their adult patients participated. Fifty-seven percent of patients reported using one or more OTC medications during the past month. Analgesics, cold or allergy products, and antacids were the most commonly used OTC medications. White patients were significantly more likely to have reported using an analgesic in the past month than non-white patients. Female, white, and younger patients were more likely to have reported using a cold or allergy product in the past month than male, non-white, and older patients. Approximately 58% of patients discussed OTC medications with their physicians. Older patients and female patients as well as patients who reported using an antacid in the past month were significantly more likely to have discussed OTC medications with their physicians. Physicians asked questions about OTC medications during only 37% of encounters. Patients asked questions about OTC medications during 11% of encounters. Patient ethnicity did not influence physician or patient question-asking and information-giving about OTC medications. Male physicians were more likely to state information and ask questions about OTC medications than female physicians. Patients were more likely to ask male physicians questions about OTC medications. Physicians were more likely to state OTC information to and ask OTC questions of female and older patients. Physicians were more likely to ask less educated patients questions about OTC medications. Less educated patients were more likely to ask physicians questions about OTC medications. Despite the fact that more than half of all patients reported using OTC medications, physicians asked questions about OTC use during only approximately one-third of encounters. Of patients who reported using an OTC medication in the past month, 58% did not tell their physicians, yet only 14% of patients believed that it was not important for the physician to know about their OTC use. Physician-patient communication about OTC medications should be encouraged so that the patient becomes a collaborative partner in medication management.

Ethnicity and physician-older patient communication about alternative therapies

OBJECTIVES

The purpose of this study was to describe ethnic differences in physician-patient communication about alternative therapies, using a data set comprised of audiotapes and transcripts of primary care medical visits.

METHODS

The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center, Albuquerque, NM. Twenty-seven (27) resident physicians and 205 of their Hispanic and non-Hispanic white patients age 50 and over participated.

RESULTS

Almost 18 percent of patients reported using one or more alternative therapies during the preceding month. Herbal medicine was the most widely used therapy. Eighty-three percent (83%) of patients who reported using an alternative therapy in the previous month did not tell their physicians. Physicians asked one or more questions about alternative therapies during only 3.4% of encounters. Only 2% of patients asked their physicians one or more questions about alternative therapies. There were no ethnic differences in physician-older patient communication about alternative therapies.

DISCUSSION

Physician-patient communication could be improved to enhance physician understanding of the spectrum of interventions patients pursue to improve their health.

Resident physician management of Hispanic and non-Hispanic white patients on antidepressants

OBJECTIVE

The purpose of this study was to examine how well resident physicians monitored Hispanic and non-Hispanic white patients who were prescribed antidepressant medication.

METHOD

Retrospective and prospective review of patients' medical records.

SETTING

Family practice and internal medicine clinics at the University of New Mexico Health Sciences Center.

PARTICIPANTS

Twenty-six resident physicians and 109 of their Hispanic and non-Hispanic white patients who were prescribed antidepressant medication when recruited into the study between March and December 1995.

MAIN OUTCOME MEASURES

(i) Whether a physician recorded an appropriate diagnosis in the patient's chart, scheduled a follow-up visit and saw the patient for a follow-up visit within four weeks of the antidepressant being prescribed, and (ii) whether a physician recorded an adequate treatment plan, a discussion of side-effects and a discussion of how well the medication was working on the date the patient was enrolled in the study.

RESULTS

Twenty-seven percent of patients were prescribed antidepressant medication. Less than half of the patients who were prescribed an antidepressant had a follow-up visit scheduled and only about one-third of patients were seen by their physician within one month of the antidepressant being prescribed. Physicians documented an adequate treatment plan in the charts of 51.1% of patients, a discussion of side-effects in 11.1% of charts and an assessment of how well the medication was working in 33.3% of charts. Younger patients and patients in better emotional health were more likely to have an adequate treatment plan documented in their chart. Patients in poorer physical health were more likely to have an adequate treatment plan documented in their chart along with a description of the effectiveness of the medication. Hispanic and non-Hispanic white patients who were prescribed antidepressants were monitored equally well by their primary care physicians.

CONCLUSION

Primary care resident physicians need further training on the importance of monitoring patients on antidepressant medication.

Physician gender and hormone replacement therapy discussion

Hormone replacement therapy (HRT) is a major issue confronting millions of women today, and general internal medicine and family practice physicians are an important source of information and counseling on this issue. Previous studies have suggested that HRT discussion and prescribing are more frequent with female than with male physicians, but others have suggested age and practice setting may be the reason for observed differences. We attempted to determine if physician gender influenced HRT discussion frequency between physicians and their patients using cross-sectional, secondary analysis of data collected at general internal medicine and family practice clinics at the University of New Mexico Health Sciences Center. Twenty-seven family practice and internal medicine resident physicians (15 female, 12 male) participated. There were 127 female patients age 45 and older. Audio-taped observations of patient-physician visits collected during 1995 for a study on patient-physician communication and patient satisfaction were used. There was less frequent discussion with female than male physicians (OR = 0.42, p = 0.0014). HRT was discussed during 51 visits. Patients initiated HRT discussion in 39.2% of visits in which it was discussed. Patients with diabetes were less likely to discuss HRT (OR = 0.25, p = 0.0122). Increasing year of physician residency was associated with decreased discussion of HRT (OR = 0.51, p < 0.0001). In this health sciences center, with physicians similar in age and training, male physicians discussed HRT significantly more often than did female physicians.

Consumer participation in health policy decisions: empowerment or puffery?

Many consumers in today's society have increased access to information about health and medical care through books, videotapes, audiotapes, the Internet, and television programming. However, consumers often are excluded from involvement in health policy decision making because it is believed that they do not have the necessary expertise. In this paper, the following will be discussed: (1) the historic role of consumer involvement in health policy decision making, (2) an overview of major barriers that consumers have encountered in health policy decision making, and (3) strategies for overcoming these barriers so that consumer empowerment can be enhanced when they serve on health policy panels.

Relationship between selected personality traits and citation for violating pharmacy board regulations

The relationship between certain personality traits and citation for pharmacy board violations was studied. The Gordon Personal Profile-Inventory (GPP-I) was mailed to three samples of pharmacists licensed in North Carolina (95 pharmacist leaders, 199 pharmacists who had been cited for violating one or more board of pharmacy regulations, and a random sample of 494 pharmacists licensed in the state). The pharmacists were asked to provide demographic information and to complete the 38-item GPP-I, which measures eight different personality traits (ascendancy, responsibility, emotional stability, sociability, cautiousness, original thinking, personal relations, and vigor). The response rates for the three samples were 78.9%, 23.6%, and 58.3%, respectively. Pharmacists who had been cited for one or more board of pharmacy violations had significantly lower scores on the GPP-I for the personality trait vigor than general pharmacists. They also had lower scores on the GPP-I traits of ascendancy, original thinking, and vigor than pharmacy leaders. They were less likely to have advanced degrees or belong to any pharmacy organizations. They tended to be male, older, and out of school longer than those pharmacists who had never been cited for violating one or more board of pharmacy regulations. Significant differences in personality traits were found between pharmacists who had been cited for violating board of pharmacy regulations and general pharmacists and pharmacy leaders.

Physician expression of empathy and positiveness to Hispanic and non-Hispanic white patients during medical encounters

BACKGROUND

This study examined the extent to which physicians expressed empathy and positiveness to Hispanic and non-Hispanic white patients during primary care visits.

METHODS

Twenty-seven family practice and internal medicine resident physicians at the University of New Mexico Health Sciences Center were audiotaped in 1995 with 427 adult patients who were fluent in English or Spanish. The tapes were reviewed and organized to measure how frequently physicians expressed empathy and positiveness to patients.

RESULTS

Physicians expressed empathy at equal rates to Hispanic and non-Hispanic white patients. When examining only Hispanic patients, physicians were significantly more likely to express empathy to patients who they knew better. Physicians expressed positiveness to non-Hispanic white patients more often than to Hispanic patients. When examining only Hispanic patients, physicians were more likely to express positiveness to patients who they knew better, who rated their health better, and who were more educated. When examining only non-Hispanic white patients, physicians were more likely to express positiveness to older and male patients than to younger and female patients. Also, female and younger physicians were significantly more likely to express positiveness to non-Hispanic white patients than male and older physicians were.

CONCLUSIONS

Our findings illustrate that the resident physicians expressed empathy equally well to Hispanic and non-Hispanic white patients but that resident physicians need further training on how to express positiveness to patients from different ethnic backgrounds, especially Hispanic patients.

Asking questions about medication: analysis of physician-patient interactions and physician perceptions

OBJECTIVES

The purpose of this research was to examine physicians' and patients' question-asking about medications during medical encounters.

METHODS

A dataset of 467 audiotapes and transcripts of outpatient visits, as well as postvisit interviews with chronic disease patients and their primary care physicians, was analyzed.

RESULTS

All patients took at least one prescribed medication and were using an average of 3.9 continued medications. Physicians and patients spent an average of 3.94 minutes, or 20% of each medical visit, discussing medications. Physicians asked patients an average of 9.3 questions about medications during each medical visit. Physicians asked significantly more questions of non-white patients, lower-income patients, and patients using more continued medications. Almost half (47%) of the patients observed did not ask any medication questions at all even though they were currently taking at least one medication; for those patients who did ask questions, the average number asked was 2.4. Starting a new medication doubled a patient's likelihood of question-asking. Physicians perceive question-asking in a positive light; patients who asked questions about medication were rated by their physicians as more interested and assertive than patients who did not ask questions, but not any more irritated or angry.

CONCLUSIONS

The findings of the study illustrate the importance of improving physicians' and patients' question-asking about medications in primary care settings so that potential problems with medications can be detected and avoided and patient compliance can be improved.

Patient race and psychotropic prescribing during medical encounters

This paper examines how patient race, rating of physical and emotional health, expression of physical, emotional, and social problem symptoms, and physician perceptions of patients' physical health, emotional health, and social problems influence psychotropic prescribing in patients with chronic illness. Data were collected at 11 geographic areas in the United States and Canada. Patient visits were audio-tape recorded and research assistants interviewed each patient after their medical visit. Physicians completed self-administered questionnaires after each visit with a participating patient. Whites were significantly more likely to receive psychotropic prescriptions than non-whites (P < 0.05). Twenty percent of white and 13.5% of black patients received prescriptions for one or more psychotropic medications. Logistic regression techniques were used to predict psychotropic prescribing to white and non-white patients respectively. Patient expression of emotional symptoms and physician perceptions of patient emotional health significantly influenced psychotropic prescribing to white patients, whereas only patient expression of emotional symptoms significantly influenced psychotropic prescribing to non-white patients. Patient expression of physical and social problem symptoms and physician perceptions of patient physical health and social problems did not influence psychotropic prescribing to white or non-white patients. The paper emphasizes the importance of training primary care physicians to probe and to provide patients with an opportunity to discuss their emotional symptoms.

Physician responses to an educational intervention on improving their long-term prescribing of sedatives

The current study examined response forms returned by physicians in response to a Medicaid retrospective therapeutic intervention on the long-term use of sedatives. The educational intervention was designed to notify physicians about their patients' long-term use of sedatives and suggest that they reevaluate the patient's need for sedative hypnotic medication and decrease or discontinue prescribing the medication and/or suggest non-pharmacological alternatives if deemed appropriate. Forty-seven percent of physicians responded to the educational intervention. Nineteen percent of responding physicians planned to change the patient's medication in some way. The most common planned change was to decrease the dose. Physicians also stated that they would recommend one or more non-pharmacological alternatives to 17% of patients. Thirty-eight percent of physicians planned to monitor and/or counsel the patient. Over 40% of physicians reported planning no action after receiving the intervention. Twenty-six percent of physicians planned no action because of patient demand for the sedatives. The study concludes that physicians need to be better trained on how to: (1) discuss non-pharmacological treatments with patients and (2) deal with and respond to patients who demand controlled substances.

Physician vs patient initiation of psychotropic prescribing in primary care settings: a content analysis of audiotapes

The primary goals of this study were to examine: (1) whether patients were involved actively in initiating the prescribing of psychotropic medications during interactions with their primary care physicians and (2) what variables influenced patient vs physician initiation of psychotropic prescribing. An analysis of 508 audiotapes of physician-patient interactions and interviews with each patient and physician from 11 different ambulatory care settings was conducted. Of 508 patients, 17% (n = 88) received prescriptions for one or more psychotropic medications. Forty-seven percent of repeat psychotropic prescriptions and 20% of new psychotropic prescriptions were initiated by patients. Logistic regression techniques showed that patients with higher incomes were more likely than their physicians to initiate psychotropic prescribing, whereas physicians were more likely to initiate psychotropic prescribing with lower income patients (P < 0.001). Patients who had more previous visits to their physician were as likely as their physicians to initiate psychotropic prescribing, whereas physicians were more likely to initiate psychotropic prescribing with patients who had been to see them fewer times in the past (P < 0.05).

Response forms reflect pharmacists' participation in retrospective DUR

This study examined pharmacists' responses to two different Medicaid retrospective therapeutic interventions (excessive use of beta 2-agonist inhalers and long-term use of sedatives) in New Mexico. It also examined the types of actions pharmacists reported taking, and the differences between actions taken by physicians and pharmacists in terms of response rate, tone of responses, and time spent responding to the intervention. The most frequent pharmacist action was to call the physician. Response rates for the drug use review (DUR) program were higher for physicians than for pharmacists; pharmacists also took twice as long as physicians to respond to both interventions. The study results indicate a need for better methods to document clinical services performed by pharmacists under the Medicaid DUR program to obtain reimbursement and justify therapeutic decisions. Pharmacists also need documentation methods that are relatively easy to use so that they can respond more quickly to interventions.

Pharmacist-patient relationships: authoritarian, participatory, or default?

The purpose of this study was to investigate the nature of pharmacist-patient relationships in New Mexico community pharmacies. A total of 344 pharmacy personnel-patient interactions were observed. Pharmacists interacted with only 57% of patients who were picking up their prescriptions. Pharmacists used an extensive participatory style with only 13% of the patients who they interacted with. Pharmacists were significantly more likely to use a participatory style with older patients and with patients who were picking up refill prescriptions. The average length of pharmacist-patient encounters was just less than 2 min (114s). Pharmacist-patient interactions were significantly longer if: (1) pharmacists used more of a participatory approach with patients and (2) pharmacists gave more drug information to patients.

Medication decision-making and management: a client-centered model

Although the traditional medical model dominates how 'provider-patient' roles are viewed, research has documented that client medication behavior strongly influences health outcomes, health care utilization, and ultimately health care costs. This paper explores the position that medication management outcomes can be improved by adopting more client-centered approaches. To examine the implications of a client-centered relationship this paper reviews research regarding client involvement in: (1) identifying treatment goals; (2) choosing from regimen options; (3) monitoring symptoms and evaluating regiments; and (4) self care with nonprescription pharmaceutical products. Based on this literature review, a collaborative client-centered model of medication consultation is examined, and implications for health care provider roles and public policy in pharmaceutical care are discussed.