title: Influence of physicians' management and communication ability on patients' persistence with antihypertensive medication.
abstract: BACKGROUND
  Less than 75% of people prescribed antihypertensive medication are still using treatment after 6 months. Physicians determine treatment, educate patients, manage side effects, and influence patient knowledge and motivation. Although physician communication ability likely influences persistence, little is known about the importance of medical management skills, even though these abilities can be enhanced through educational and practice interventions. The purpose of this study was to determine whether a physician's medical management and communication ability influence persistence with antihypertensive treatment.
  
  
  METHODS
  This was a population-based study of 13,205 hypertensive patients who started antihypertensive medication prescribed by a cohort of 645 physicians entering practice in Quebec, Canada, between 1993 and 2007. Medical Council of Canada licensing examination scores were used to assess medical management and communication ability. Population-based prescription and medical services databases were used to assess starting therapy, treatment changes, comorbidity, and persistence with antihypertensive treatment in the first 6 months.
  
  
  RESULTS
  Within 6 months after starting treatment, 2926 patients (22.2%) had discontinued all antihypertensive medication. The risk of nonpersistence was reduced for patients who were treated by physicians with better medical management (odds ratio per 2-SD increase in score, 0.74; 95% confidence interval, 0.63-0.87) and communication (0.88; 0.78-1.00) ability and with early therapy changes (odds ratio, 0.45; 95% confidence interval, 0.37-0.54), more follow-up visits, and nondiuretics as the initial choice of therapy. Medical management ability was responsible for preventing 15.8% (95% confidence interval, 7.5%-23.3%) of nonpersistence.
  
  
  CONCLUSIONS
  Better clinical decision-making and data collection skills and early modifications in therapy improve persistence with antihypertensive therapy.
authors.affiliation: Department of Medicine, McGill University, 1140 Pine Ave W, Montreal, QC, H3A 1A3 Canada. robyn.tamblyn@mcgill.ca
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: Dale
authors.initials: D
authors.lastname: Dauphinee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wenghofer
authors.forename: André
authors.initials: A
authors.lastname: Jacques
authors.forename: Daniel
authors.initials: D
authors.lastname: Klass
authors.forename: Sydney
authors.initials: S
authors.lastname: Smee
authors.forename: Tewodros
authors.initials: T
authors.lastname: Eguale
authors.forename: Nancy
authors.initials: N
authors.lastname: Winslade
authors.forename: Nadyne
authors.initials: N
authors.lastname: Girard
authors.forename: Ilona
authors.initials: I
authors.lastname: Bartman
authors.forename: David L
authors.initials: DL
authors.lastname: Buckeridge
authors.forename: James A
authors.initials: JA
authors.lastname: Hanley
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003142:Communication; D003657:Decision Making; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000627:therapeutic use*; D011446:Prospective Studies; D011792:Quebec; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D055553:Prescription Drugs