Doctors Don't Adequately Monitor Medication Adherence

FINDINGS: Patients' non-adherence to prescribed medication costs the U.S. health care system an estimated $290 billion annually and can lead to poor clinical outcomes, increased hospitalizations and higher mortality.

In an effort to understand the extent to which health care providers feel responsible for their patients' medication adherence, UCLA researchers and colleagues conducted focus-group discussions with providers and recorded out-patient office visits with 100 patients taking a total of 410 medications. They also examined how adherence discussions were initiated between providers and patients.

The researchers found that providers felt responsible for assessing and addressing adherence but believed patients were ultimately responsible. The researchers also found that physician–patient interactions were conducted in a way that might address adherence for 62 percent of the 410 medications; these interactions included simple inquiries about adherence for 31.5 percent of the medications but in-depth questions about adherence for only 4.3 percent of the medications. Patients spontaneously disclosed their non-adherence in 51 percent of 39 identified instances of non-adherence.

IMPACT: The research highlights the need to develop better methods for physicians to identify non-adherence and to change that behavior.

AUTHORS: Authors included Derjung M. Tarn, Thomas J. Mattimore and Neil S. Wenger of UCLA; Douglas S. Bell of UCLA and the RAND Corp.; and Richard L. Kravitz of UC Davis. JOURNAL: The research is published in the June issue of the Journal of the American Geriatrics Society.

FUNDING: The study was funded by the Robert Wood Johnson Foundation (grant 034384), the Agency for Healthcare Research and Quality (grant 1U18HS016391), a UCLA Mentored Clinical Scientist Development Award (5K12AG001004), and the UCLA Older Americans Independence Center (NIH's Natoinal Institute on Aging, grant P30-AG028748).