201324 Better Communications, Better Health: The Association Between Doctor-Patient Relationships and Patient Adherence

Monday, November 9, 2009

Stephanie A. Mika , The Commonwealth Fund, Washington, DC
Gretchen W. Hagelow, MPA , The Commonwealth Fund, New York, NY
Elizabeth K. Hodgman , The Commonwealth Fund, New York, NY
Michelle M. Doty, PhD , The Commonwealth Fund, New York, NY
Purpose: To identify and examine ways in which the doctor-patient relationship may influence patient adherence to medical advice or treatment.

Methods: Using data from a random, national cross-sectional telephone-based survey of 3,535 adults, we estimated the association between non-adherence to medical advice and treatment for various reasons including cost, potential side effects, and disagreement about treatment or conflict with personal beliefs, and certain critical aspects of the doctor-patient relationship such as level of trust, clarity of instructions, and shared decision-making.

Results: We found significant associations between patient adherence to medical advice across reasons for non-adherence and every aspect of the doctor-patient relationship. After controlling for a series of demographic and socio-economic characteristics including insurance status, income, education, and language, the odds of non-adherence for any reason were significantly higher among patients with a poor doctor-patient relationship or poor doctor-patient communications than those with an excellent relationship or excellent communications (respectively, OR 1.73, p <.01; OR 1.40, p<.05). Importantly, many demographic characteristics, including race, gender, and poverty level showed no association, whereas other factors such as health insurance and language were strongly associated with adherence. The odds of non-adherence due to cost were twice as high among individuals who had any gap in insurance coverage during the previous 12 months than those who were continually insured (OR 2.05, p<.01). Similarly, the odds of non-adherence for any reason were more than twice as high among Spanish speakers than English speakers (OR 2.21, p<.05).

Conclusion: Patient adherence can improve health outcomes and decrease mortality rates, while non-adherence can result in costly, unnecessary care. High-quality doctor-patient relationships, strongly associated with increased patient adherence, therefore have the potential to increase both the efficiency and effectiveness of the health care system.

Learning Objectives:
(1) Analyze the relationship between doctor-patient relationships and communications and patient adherence to medical advice or treatment.

Keywords: Adherence, Patient Perspective

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an MPH candidate in health policy and have conducted prior research in child development and psychology requiring data analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.