title: Aspects of patient and clinician language predict adherence to antidepressant medication.
abstract: OBJECTIVE
  High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.
  
  
  METHODS
  We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.
  
  
  RESULTS
  Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: rs ≥0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: rs ≥0.25; P < .05). In an adjusted analysis, empathy (t = 2.3; P = .027) and ≥2 CT statements (t = 2.3; P = .024) were associated with higher PDC.
  
  
  CONCLUSIONS
  Clinician empathy, reflections, and MIAs may elicit patient CT, whereas empathy and CT seem to enhance filling an initial prescription and PDC.
authors.affiliation: Denver Health & Hospital Authority, Denver, CO, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Kaplan
authors.forename: Robert D
authors.initials: RD
authors.lastname: Keeley
authors.forename: Matthew
authors.initials: M
authors.lastname: Engel
authors.forename: Caroline
authors.initials: C
authors.lastname: Emsermann
authors.forename: David
authors.initials: D
authors.lastname: Brody
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003120:Colorado; D003866:Depressive Disorder / Q000188:drug therapy*; D004645:Empathy; D005260:Female; D006801:Humans; D007802:Language; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D062405:Motivational Interviewing; D015999:Multivariate Analysis; D010565:Persuasive Communication; D010817:Physician-Patient Relations
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressive Agents; Communication; Depression; Patient Adherence; Quantitative Evaluation