Abstract Background Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Methods Thorough search of published literature - August producing separate effects from correlational studies and 21 experimental interventions.
All rights reserved This article has been cited by other articles in PMC. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors.
Patients must be given the opportunity to tell the story of their unique illness experiences. Physician—patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence.
Patient nonadherence sometimes called noncompliance can take many forms; the advice given to patients by their healthcare professionals to cure or control disease is too often misunderstood, carried out incorrectly, forgotten, or even completely ignored.
Nonadherence carries a huge economic burden. Yearly expenditures for the consequences of nonadherence have been estimated to be in the hundreds of billions of US dollars DiMatteo b. In addition to the most obvious direct costs, nonadherence is also a risk factor for a variety of subsequent poor health outcomes, including as many as deaths each year Smith ; Burman et al ; Christensen and Ehlers ; Kane et al The corpus of literature on patient adherence is large, and there are many conceptual models that attempt to integrate a large number of complex factors that affect adherence Bowen et al To manage the size and complexity of the empirical findings of this massive research enterprise, reliance on meta-analytic work is necessary to provide the building blocks for data-driven models of patient adherence.
Currently, ongoing meta-analytic studies at the University of California, Riverside, USA, are beginning to identify a number of stable and consistent factors that affect patient adherence DiMatteo ac ; DiMatteo et al Syntheses of the literature, along with new empirical advances, highlight the complexities inherent in understanding and effecting changes in patient adherence and suggest solutions to common problems in medication management.
Much that has been learned from recent research on the communication between healthcare providers and their patients can lessen the economic burden of nonadherence and improve healthcare processes and outcomes for patients.
Adherence to recommendations involving lifestyle changes such as exercise frequently poses significant difficulties for patients.
Such programs, of course, tend to be more successful in supervised rather than home-based programs McKelvie et al The health consequences of nonadherence can be quite severe. Nonadherence compromises patient outcomes in many different ways but is most obvious when patients fail to take medications that likely would cure or at least effectively manage their illnesses Miller ; Chesney et al ; Weir et al For patients suffering from or those at risk of coronary heart disease, nonadherence to medication treatments can jeopardize survival McDermott Among diabetic patients, adherence to medication for controlling hypertension is essential to preventing mortality from diabetes and myocardial infarction Elliott et al Further, aside from direct biomedical benefits, studies show that health may depend partly upon the act of adhering to a regimen.
Some research suggests that adherence, even to a placebo, is itself beneficial to health outcomes McDermott ; Irvine et al Thus, not only do nonadherent patients fail to benefit from effective medication, they also risk being harmed by less than ideal medication and dosage choices Joshi and Milfred ; Salzman ; Bedell et al Relatedly, the risk of new illness may increase in the context of nonadherence, such as when antibiotic-resistant bacterial infections develop because patients have not taken their full, prescribed doses of antibiotics Harrison ; Lutfey et al ; Graham ; Rao ; Raviglione et al Thus, it is clear that nonadherence often results in a combination of wasted medical care dollars Johnson and Bootman ; Rizzo and Simons ; DiMatteo bwasted time and energy for patients and healthcare providers alike DiMatteo et aland frustration and dissatisfaction for all interactants.
Research on patient adherence The research literature on patient adherence is extensive.
Over the past 50 years, there have been 32 adherence related citations in PubMed and 10 in PsychLit. These various methods are used in the context of a vast array of disease conditions both chronic and acute.
With technologies such as these, every removed dose of medication sends an electronic signal to the physician with the date and time the bottle was opened Eisen et alproviding a very reliable indicator of medication access despite the remaining possibility that the dose was removed but not actually taken as prescribed.
Direct observation of a patient taking medication is another, albeit more energy-intensive, method for assessing adherence Volmink et al Pharmacy records represent another resource for measuring adherence.
Recent studies have analyzed pharmacy claims databases involving large numbers of patient records and indicating such data as when the medication was obtained and whether prescriptions were refilled on schedule Tai-Seale et al ; Bieszk et al Understanding adherence requires a multi-method approach to give a clear and accurate picture of whether and how medical recommendations are being followed.
Adherence needs to be measured using multiple tools. For example, adherence to antidepressant medication might be assessed by pill count, patient self-report, and MEMS Thompson et al ; Hamilton Just as studies of adherence vary greatly in the way they measure the construct, they also range widely in scope and application.
Some studies focus on variations in rates of nonadherence DiMatteo csome on particular types of nonadherence and their associations with patient outcomes DiMatteoothers on the correlates of adherence DiMatteoaand still others on the ways clinicians can improve adherence rates for their patients Roter et al ; Atreja et al Meta-analytic techniques are now being used as well Macharia et al ; DiMatteo et al; McDonald et al ; Peterson ; Ismail Improved Patient Satisfaction Effective doctor patient communication is shown to be highly correlated with patient satisfaction with health care Good doctor patient communication is important and has multiple impacts on various aspects of health Communication Skills and Doctor Patient Relationship MD, CCFP, FRACGP, Prof.
Albert Lee MD. Health communication covers a wide range of topics, but a central focus is health care provider-patient communication, specifically, issues involving patient satisfaction and compliance. Patient compliance is defined as "the extent to which patients follow clinical prescriptions".
Successful communication between physicians and patients promotes greater patient satisfaction with medical care, which in turn fosters higher levels of adherence. Patients' trust in their physicians is essential to their emotional disclosure and is therefore a crucial component of the patient–physician relationship.
Patient-perceived physician empathy significantly influenced patient satisfaction and compliance via the mediating factors of information exchange, perceived expertise, inter-personal trust, and partnership.
Improving physician empathic communication skills should increase patient satisfaction and compliance. DOCTOR-PATIENT COMMUNICATION: A REVIEW OF THE LITERATURE L M. L. ONG, I J. C satisfaction, compliance/adherence to treatment, recall and understanding of information, and health peutical background claim that the importance of a good doctor-patient relationship is determined by its therapeutic qualities.
Irwin et al.  see clinical. Patient-physician communication is an integral part of clinical practice. When done well, such communication produces a therapeutic effect for the patient, as has been validated in controlled studies.
Formal training programs have been created to enhance and measure specific communication .