Physician Communication Skills Essential for Patient Adherence

How well patients follow their doctor’s orders is significantly related to the communication skills of their physicians, researchers at the University of California, Riverside and Texas State University, San Marcos have found in an analysis of more than 100 previous studies.

Adherence to prescribed medical regimens can be improved when physicians are trained to be better communicators, Robin DiMatteo, distinguished professor of psychology at UCR, and Kelly Haskard, assistant professor of psychology at TSU, wrote in an article, “Physician Communication and Patient Adherence to Treatment: A Meta-analysis,” published today in the journal Medical Care.

Haskard, the article’s lead author, and DiMatteo reviewed 127 studies published between 1949 (when citations were first indexed in Medline) and Aug. 31, 2008. The studies were published in peer-reviewed, English-language journals and assessed physicians’ communication skills and their patients’ adherence, or the effectiveness of communication skills training for physicians in improving their patients’ adherence.

They found that patients of physicians who communicate well have a 19 percent higher rate of adherence, and that training physicians in communication skills improves patient adherence by 12 percent.

Studies show that 25 percent to 50 percent of patients do not follow their doctors’ orders, presenting a significant challenge for medical professionals, patients and researchers, DiMatteo and Haskard wrote. Haskard was a UCR graduate student in psychology when the meta-analysis began.

“We have limited health care resources,” DiMatteo said. “They are wasted if people don’t follow through on treatment.”

Communication is an essential component of the medical care process, Haskard and DiMatteo confirmed. It contributes to patients’ understanding about their illness and the risks and benefits of treatment, offers encouragement, and helps in gathering and using the resources needed to follow prescribed regimens, all of which enhances adherence.

Effective physician-patient communication is linked empirically to outcomes of care including patients’ satisfaction, health status, recall of information and adherence, the researchers wrote.

They noted a 2005 National Ambulatory Medical Care Survey that reported 963.6 million medical visits in the United States. If a quarter of those patients did not adhere to treatment regimens (the low end of estimates of nonadherence), approximately 240 million of those visits - and millions of dollars - may have been wasted, DiMatteo said.

Using the percentage difference in adherence for patients whose physician communicated well versus patients whose physician did not (19 percent), more than 183 million visits that resulted in patient nonadherence would have resulted in better patient adherence if the physician had strong interpersonal communication, Haskard and DiMatteo found.

“These estimates are only suggestive, of course, but point to the potential importance of communication in reducing wasted health care resources that result from nonadherence,” the researchers determined. “It is, of course, essential to note that adherence contributes to better outcomes only when diagnosis and treatment are correct and appropriate, underscoring the centrality of promoting adherence to evidence-based care that is targeted to the benefit of the individual patient.”

Although lack of consensus remains about the most important barriers to and strategies for achieving adherence, DiMatteo and Haskard said, their meta-analytic study makes a compelling argument for the importance of improving physician-patient communication.

“For many patients, being able to communicate openly and honestly with their physician about their own challenges with a regimen, obtaining all of the information they need, feeling supported and encouraged, and feeling involved in making decisions about their care may be of great benefit to their achievement of adherence,” the researchers said. “Such effective communication may help to reduce barriers that stand in the way of optimal health outcomes.”

Provided by University of California, Riverside