Physician-patient communication may improve medication adherence

San Diego—The answer to low patient adherence to glaucoma medications may be as simple as improving communication, according to researchers. Harry A. Quigley, MD, of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and his colleagues studied physician-patient communication to determine ophthalmologists’ proficiency for detecting and dealing with patient non-adherence to medications.

Fifty glaucoma patient encounters (second visits) with 23 ophthalmologists in three states were videotaped and analyzed. “This direct observation and analysis of doctor-patient communication in glaucoma was like ‘reality TV comes to the eye doctor’s office,’ ” Dr. Quigley said.

All of the physicians and patients knew they were being videotaped. Physicians and patients completed post-visit questionnaires, and patients were interviewed by the researchers.
Of the 13 patients judged non-adherent to their medications by the interviewers, the ophthalmologists only identified three of them. Eleven patients admitted in a post-visit interview that they had missed medications during the past week; the ophthalmologists only identified three such patients.

How is this happening? It may be that the physician-patient conversations are too physician-centered, according to Dr. Quigley.

“We found that the doctors spoke 70% of all the words and asked two-thirds of all the questions,” he said. More than 90% of all questions asked by the physicians were closed-ended and only 18% of the patients were asked whether they understood the disease of glaucoma, he added.

Possible solutions include teaching ophthalmologists to ask more open-ended questions, making sure patients understand the disease and the importance of treatment, and asking questions specifically designed to identify non-adherence, he said.

Rethinking how technicians examine and prime patients before they are seen by the physician can mean more time for conversation and less time necessary for examination, thus leading to more opportunities for communication without increasing “chair time,” Dr. Quigley concluded.