Simple conversations between healthcare providers and their low-income patients can improve adherence to blood pressure medications.
Medication nonadherence has been linked with an increased risk of hospitalization for conditions ranging from heart failure to diabetes to psychosis.
Income level also often effects hospitalizations, with research showing that lower income patients are more likely to be hospitalized for things like asthma, peripheral artery disease, and acute myocardial infarction.
Now, new research in the journal Circulation: Cardiovascular Quality and Outcomes suggests that simple conversations between healthcare providers and their low-income patients can boost adherence to blood pressure medications.
Researchers found that patients were three times less likely to take their high blood pressure medications when their providers did not have a collaborative communication style, such as asking open-ended questions and checking patients' understanding of medication instructions.
Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues such as employment, housing, and partner relationships.
“When healthcare providers ask patients about life challenges or take the time to check their patient’s understanding of instructions, it signals that their healthcare provider genuinely cares about them and provides the motivation and confidence to manage their health issues on their own,” Antoinette Schoenthaler, EdD, lead author for the study and an associate professor of medicine at NYU School of Medicine, said in a statement.
The researchers audiotaped interactions between 92 patients and 27 providers over a three-month period from three practices that serve a multiethnic, low-income population in New York City. They measured whether patients took their medications during the study period using an electronic monitoring device that recorded the time and date each time they opened the pill bottle.
In addition to adherence rates overall, the study also found that black patients were more likely than white patients to have poor adherence to their blood pressure medications. Moreover, compared to the overall patient population, non–adherence was more pronounced with black patients when social issues were not discussed (eight times less likely to take medication as prescribed compared to six).
“Healthcare providers should talk to patients about the things that get in the way of taking their medication, such as relationship status, employment and housing. Unemployment, for example, affects whether patients can afford medication, which is a primary risk factor for non–adherence. If these issues go undiscussed, healthcare providers may never figure out why patients are not taking their medications,” said Schoenthaler.
In related news, last month, the National Quality Forum declined to endorse adding social risk factors to most of the Centers for Medicare & Medicaid Services readmissions measures.
Alexandra Wilson Pecci is an editor for HealthLeaders.
