title: How do providers assess antihypertensive medication adherence in medical encounters?
abstract: BACKGROUND
  Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. Providers' communication with patients about their medication-taking behavior may be central to improving adherence.
  
  
  OBJECTIVE
  The goal of this study was to characterize the ways in which providers ask patients about medication taking.
  
  
  METHODS
  Clinical encounters between primary care providers and hypertensive patients were audiotaped at 3 Department of Veterans' Affairs medical centers.
  
  
  METHODS
  Primary care providers (n=9) and African-American and Caucasian patients (n=38) who were diagnosed with hypertension (HTN).
  
  
  METHODS
  Transcribed audiotapes of clinical encounters were coded by 2 investigators using qualitative analysis based on sociolinguistic techniques to identify ways of asking about medication taking. Electronic medical records were reviewed after the visit to determine the BP measurement for the day of the taped encounter.
  
  
  RESULTS
  Four different aspects of asking about medication were identified: structure, temporality, style and content. Open-ended questions generated the most discussion, while closed-ended declarative statements led to the least discussion. Collaborative style and use of lay language were also seen to facilitate discussions. In 39% of encounters, providers did not ask about medication taking. Among patients with uncontrolled HTN, providers did not ask about medications 33% of the time.
  
  
  CONCLUSIONS
  Providers often do not ask about medication-taking behavior, and may not use the most effective communication strategies when they do. Focusing on the ways in which providers ask about patients' adherence to medications may improve BP control.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA. bokhour@bu.edu
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D010349:Patient Compliance; D010817:Physician-Patient Relations; D013637:Tape Recording; D014481:United States
chemical_list: D000959:Antihypertensive Agents