Influence of physicians' management and communication ability on patients' persistence with antihypertensive medication.
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.
Tamblyn
Robyn
R
Department of Medicine, McGill University, 1140 Pine Ave W, Montreal, QC, H3A 1A3 Canada. robyn.tamblyn@mcgill.ca
Abrahamowicz
Michal
M
Dauphinee
Dale
D
Wenghofer
Elizabeth
E
Jacques
André
A
Klass
Daniel
D
Smee
Sydney
S
Eguale
Tewodros
T
Winslade
Nancy
N
Girard
Nadyne
N
Bartman
Ilona
I
Buckeridge
David L
DL
Hanley
James A
JA
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
D000959:Antihypertensive Agents; D055553:Prescription Drugs