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PCPs, patients often at odds over drug importance, adherence

There is substantial discordance between patients and PCPs in terms of the importance of certain drugs, as well as drug adherence, with nearly 20% of medications considered important to physicians not being correctly taken by patients, according to data published in the Annals of Family Medicine.

According to the researchers, PCPs may be able to improve drug adherence, and reconcile disagreements over medication, by encouraging better patient–physician communication and collaboration in treatment. Shared decision making, projecting a nonthreatening demeanor and pharmacist counseling may also be successful.

In addition, researchers found that some drugs patients were taking correctly were rated as not important by physicians, suggesting possible polypharmacy and a higher burden of treatment. They recommended reducing the number of unnecessary medications, and reinforcing adherence to those considered important.

“Nonadherence, defined as the extent to which a person’s behavior fails to coincide with medical advice, may lead to negative outcomes and long-term mortality, especially among patients with chronic conditions and on complex medication regimen,” Stéphanie Sidorkiewicz, MD, of the department of general medicine at Paris Descartes University in France, and colleagues wrote. “Approximately 50% of patients stop taking their medications 6 months after drug initiation. Reasons for nonadherence go beyond simple forgetfulness. Patients’ perceptions and beliefs are crucial in their medication-taking behaviors.”

To compare patient and physician views on drug importance and adherence, as well as adherence reported by patients with importance assessed by their PCPs, the researchers recruited 128 patients, taking 498 medications, from 6 general practices and 6 care units of university hospitals in France. Participants were aged 18 years and older and were receiving at least one long-term drug treatment from both hospital and ambulatory settings.

The researchers compared drug adherence reported by patients to drug importance as determined by physicians, using Spearman correlation coefficients. In addition, patient-reported reasons for nonadherence were collected through open-ended questions and classified as either intentional or nonintentional.

According to the researchers, there exists only “weak agreement” between patients and physicians in drug adherence assessments (r = –0.25; 95% CI, –0.37 to –0.11), as well as drug importance (r = 0.07; 95% CI, 0-0.13). In addition, the researchers reported no correlation between what drugs physicians determined important and patient-reported drug adherence (r = –0.04; 95% CI, –0.14 to 0.06). Of the drugs considered important by physicians, 18.9% were taken incorrectly by patients. Patients also intentionally failed to adhere to 48.1% of the drugs in which they reported reasons for nonadherence.

“Our findings highlight the importance of regularly assessing adherence, medication by medication, for patients who are on drugs long term,” Sidorkiewicz and colleagues wrote. “If patients show poor adherence, physicians should reconsider the risk–benefit balance of the drugs. Some drugs have a low value and may be responsible for harmful interactions or adverse effects. In certain cases, an unfavorable risk–benefit balance of the drug combined with patient nonadherence may lead physicians to consider deprescription.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

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