Patient–provider communication, self-reported medication adherence, and race in a postmyocardial infarction population

Abstract

Leah L Zullig,1,2 Ryan J Shaw,1,3 Bimal R Shah,4,5 Eric D Peterson,4,5 Jennifer H Lindquist,1 Matthew J Crowley,1,2 Steven C Grambow,6 Hayden B Bosworth1–3,7 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Division of General Internal Medicine, Duke University, Durham, NC, USA, 3School of Nursing, Duke University, Durham, NC, USA, 4Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA; 5Duke Clinical Research Institute, Duke University Durham, NC, USA; 6Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA, 7Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Objectives: Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients’ race. Methods: We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors. Results: Overall, 298 patients (74%) reported never leaving their doctor’s office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor’s office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19–3.92) and those of minority race (OR: 1.19; 95% CI: 0.54–2.66), the overall interaction effect was not statistically significant (P=0.24). Conclusion: The quality of patient–provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients’ race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds. Keywords: acute myocardial infarction, hypertension, health policy and outcome research, communication