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Research ArticleOriginal Research

Intervention to Enhance Communication About Newly Prescribed Medications

Derjung M. Tarn, Debora A. Paterniti, Deborah K. Orosz, Chi-Hong Tseng and Neil S. Wenger
The Annals of Family Medicine January 2013, 11 (1) 28-36; DOI: https://doi.org/10.1370/afm.1417
Derjung M. Tarn
1Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
MDPhD
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  • For correspondence: dtarn@mednet.ucla.edu
Debora A. Paterniti
2Center for Healthcare Policy and Research and Department of Sociology, University of California-Davis Medical Center, Sacramento, California
PhD
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Deborah K. Orosz
3Harvard Medical School, Boston, Massachusetts
BA
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Chi-Hong Tseng
4Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
PhD
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Neil S. Wenger
4Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
MDMPH
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  • Figure 1
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    Figure 1

    Flowchart of study participants.

  • Figure 2
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    Figure 2

    Medical Communication Index scores for medications prescribed by intervention and control group physicians.

    a <.001.

    b <.01.

  • Figure 3
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    Figure 3

    Percentage of medications for which Medication Communication Index component was discussed.

    a P <.01.

    b P <.05.

    c P ≤.001.

Tables

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    Table 1

    Characteristics of Physicians

    CharacteristicPrescribing aNew Medication(N = 18)Intervention Group (n = 10)Control Group (n = 8)
    Age, mean (SD), y38.8 (11.3)41.6 (13.7)35.3 (6.5)
    Female, No. (%)7 (39)4 (40)3 (38)
    Race/ethnicity, No. (%)
    White11 (61)6 (60)5 (63)
    Asian7 (39)4 (40)3 (38)
    Years in practice, mean (SD)13.7 (11.8)16.4 (14.3)10.3 (7.3)

    Note: No difference between intervention and control group physicians was statistically significant.

      • View popup
      Table 2

      Characteristics of Patients

      CharacteristicAll Patients (N = 256)Prescribed a New Medication (n = 82)Not Prescribed a New Medication (n = 174)Prescribed a New Medication
      Intervention Group (n = 46)Control Group (n = 36)
      Age, mean (SD), y64.8 (10.5)60.5 (8.0)66.8 (11.0)60.3 (7.9)60.7 (8.3)
      Female, No. (%)150 (58.6)50 (61.0)100 (57.5)30 (65.2)20 (55.6)
      Race/ethnicity, No. (%)
        White158 (61.7)49 (59.8)109 (62.6)26 (56.5)23 (63.9)
        African-American43 (16.8)15 (18.3)28 (16.1)7 (15.2)8 (22.2)
        Hispanic24 (9.4)12 (14.6)12 (6.9)9 (19.6)3 (8.3)
        Asian21 (8.2)5 (6.1)16 (9.2)3 (6.5)2 (5.6)
        Other8 (3.1)1 (1.2)7 (4.0)1 (2.2)0 (0)
      Education, No. (%)
        High school or less45 (17.7)15 (18.5)30 (17.4)10 (22.2)5 (13.9)
        Some college85 (33.3)28 (34.8)57 (32.8)15 (33.3)13 (36.1)
        College graduate125 (49.0)38 (46.9)87 (50.0)20 (44.4)18 (50.0)
      Health literacy score, mean (SD)a6.7 (0.89)6.8 (0.49)6.7 (1.0)6.8 (0.53)6.9 (0.44)
      Medications and dietary supplements, mean (SD), No.6.8 (4.4)6.7 (3.9)6.8 (4.6)6.7 (3.6)6.6 (4.2)
      Confidence about interacting with physicians, mean score (SD)b8.6 (1.5)8.6 (1.5)8.6 (1.6)8.9 (1.1)8.3 (1.9)
      Seen by internal medicine physician, No. (%)158 (61.7)55 (67.1)103 (59.2)30 (65.2)25 (69.4)
      Seen by attending physician, No. (%)225 (87.9)71 (86.6)154 (88.5)40 (87.0)31 (86.1)
      Seen by patient’s regular physician, No. (%)214 (86.0)64 (82.1)150 (87.7)36 (83.7)28 (80.0)
      Previous visits to physician, No. (%)
        Never36 (14.8)15 (19.2)21 (12.7)5 (11.9)10 (27.8)
        1-235 (14.4)11 (14.1)24 (14.6)7 (16.7)4 (11.1)
        3-549 (20.2)13 (16.7)36 (21.8)7 (16.7)6 (16.7)
        6-1248 (19.7)14 (18.0)34 (20.6)8 (19.1)6 (16.7)
        >1275 (30.9)25 (32.1)50 (30.3)15 (35.7)10 (27.8)
      • ↵a Health literacy ranges from 0-7, with higher scores indicating greater health literacy.

      • ↵b Confidence about interacting with physicians ranges from 0-10, with higher scores indicating greater self-efficacy.

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      Table 3

      Effect of Intervention on Patients’ Reports About Physician Communication and Medication

      ReportNo. of PatientsAll PatientsIntervention GroupControl GroupP Value a
      About physician
      Overall communication, mean score (SD)825.67 (0.60)5.74 (0.54)5.59 (0.66).49
      Trust in physician, mean score (SD)824.68 (0.55)4.72 (0.52)4.62 (0.59).68
      Communication about new medication, No. (%)b1117.90 (2.81)8.78 (2.23)6.87 (3.09).02
        What medicine is called107103 (96.3)56 (94.9)47 (97.9).53
        What medicine is for106105 (99.1)57 (98.3)48 (100).36
        Why medicine is important to take10390 (87.4)51 (89.5)39 (84.8).63
        How to take the medicine10295 (93.1)54 (96.4)41 (89.1).07
        How long to take medicine10392 (89.3)56 (96.6)36 (80.0).03
        How to get further medicine supply (if applicable)8169 (85.2)42 (82.4)30 (90.9).37
        Whether medicine has side effects10375 (72.8)50 (86.2)25 (55.6).001
        Risk of getting side effects10564 (61.0)43 (76.8)21 (42.9).003
        What to do if side effects occur10063 (63.0)40 (74.1)23 (50.0).008
        Interactions with other medicines10062 (62.0)43 (81.1)19 (40.4)<.001
      About new medication immediately after the visit
      Planning to take new medication, No. (%)110107 (97.3)59 (98.3)48 (96.0).56
      Certainty about taking new medication, mean score (SD)1118.94 (2.16)9.30 (1.96)8.51 (2.29).04
      Importance of new medication, mean score (SD)1113.61 (0.62)3.65 (0.61)3.57 (0.64).52
      Worry about condition medication is for, mean score (SD)1112.36 (1.02)2.45 (1.08)2.25 (0.93).32

      Note: Data are presented as mean (SD) unless otherwise indicated. Unit of analyses for overall communication and trust in physician is the patient; unit of analyses for all other outcomes is the new medication. Overall communication ranges from 1 to 6; trust in physician ranges from 1 to 5; communication about new medication and certainty about taking new medication range from 0 to 10; and importance of new medication and worry about condition range from 1 to 4. Higher scores indicate better communication, more trust, and greater certainty, importance, and worry.

      • ↵a P value describes difference between intervention and control group patients.

      • ↵b The 10 items comprising the communication about new medication scale are listed and describe the number and percentage of patients who reported receiving “about the right amount” of information about the item.

      • View popup
      Table 4

      Relationship between Medication Communication Index (MCI) and Patients’ Reports about Physician and Medication

      ReportNo.Mean MCI Score (SD)R2P Valuea
      About physician
      Communication about new medication1080.13.003
        What medicine is called (about right)1003.45 (1.2).17
        What medicine is called (insufficient)43.75 (1.0)
        What medicine is for (about right)1023.44 (1.2)<.0 01
        What medicine is for (insufficient)14 (-)
        Why medicine is important to take (about right)873.51 (1.2).42
        Why medicine is important to take (insufficient)132.96 (1.4)
        How to take the medicine (about right)923.50 (1.2).87
        How to take the medicine (insufficient)73.14 (1.4)
        How long to take medicine (about right)893.60 (1.2).03
        How long to take medicine (insufficient)112.27 (1.3)
        How to get further medicine supply693.54 (1.2)
        (if applicable) (about right).71
        How to get further medicine supply123.79 (1.3)
        (if applicable) (insufficient)
        Whether medicine has side effects (about right)723.78 (1.1).02
        Whether medicine has side effects (insufficient)282.80 (1.3)
        Risks of getting side effects (about right)613.81 (1.1)<.0 01
        Risks of getting side effects (insufficient)412.84 (1.3)
        What to do if side effects occur (about right)613.83 (1.1)<.001
        What to do if side effects occur (insufficient)362.88 (1.3)
        Interactions with other medicines (about right)593.70 (1.1).07
        Interactions with other medicines (insufficient)383.05 (1.3)
      About new medication
      Planning to take new medication1043.45 (1.2).46
      Not planning to take new medication32.83 (1.8)
      Certainty about taking new medication1080.01.62
      Importance of new medication108<0.01.76
      Worry about condition medication is for1080.03.11

      Note: The MCI is a 5-point index calculated by assigning 1 point to each of the following elements if they are discussed during an office visit: medication name, purpose of use, duration of use, potential side effects. Counseling about the number of tablets or sprays and how often to use a medication is given 0.5 points each.

      • ↵a P value describes differences between MCI scores for categorical variables, and relationship between MCI and patient reports for continuous variables.

    Additional Files

    • Figures
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    • The Article in Brief

      Intervention to Enhance Communication About Newly Prescribed Medications

      Derjung M. Tarn , and colleagues

      Background This study tests a program to improve doctor-patient communication about newly prescribed medications. In particular, the study looks at 5 elements of communication about medications (discussion of medication name, purpose, directions for use, duration of use, and side effects), as well as patients' ratings of communication about new prescriptions.

      What This Study Found A program to improve patient education and counseling about new medications by targeting physician communication appears to be effective. On average, doctors who participate in the program address more than 1 of 5 additional elements of basic information compared with control group physicians; they also have more discussions than control group doctors about all 5 major elements emphasized by the intervention. Furthermore, the intervention results in patients reporting better communication about medication information.

      Implications

      • When doctors introduce a new medication, it sets the stage for whether and how patients will initiate use of the medication. The authors call for future research testing the clinical impact of the intervention.
    • Supplemental Appendixes 1-2

      Supplemental Appendix 1. Study Intervention Slides; Supplemental Appendix 2. Patient Intervention Handout

      Files in this Data Supplement:

      • Supplemental data: Appendixes 1-2 - PDF file, 6 pages, 1.6 MB
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    Intervention to Enhance Communication About Newly Prescribed Medications
    Derjung M. Tarn, Debora A. Paterniti, Deborah K. Orosz, Chi-Hong Tseng, Neil S. Wenger
    The Annals of Family Medicine Jan 2013, 11 (1) 28-36; DOI: 10.1370/afm.1417

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    Intervention to Enhance Communication About Newly Prescribed Medications
    Derjung M. Tarn, Debora A. Paterniti, Deborah K. Orosz, Chi-Hong Tseng, Neil S. Wenger
    The Annals of Family Medicine Jan 2013, 11 (1) 28-36; DOI: 10.1370/afm.1417
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