Research ArticleOriginal Research

Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians

Stéphanie Sidorkiewicz, Viet-Thi Tran, Cécile Cousyn, Elodie Perrodeau and Philippe Ravaud
The Annals of Family Medicine September 2016, 14 (5) 415-421; DOI: https://doi.org/10.1370/afm.1965

Article Figures & Data

Tables

  • Table 1

    Patient Characteristics (N = 128)

    CharacteristicValue
    Age, median (IQR), y59.8 (42.5–72.4)
    Sex, male, No. (%)37 (28.9)
    Marital status
     Married or in civil union, No. (%)49 (37.8)
     Live-in partner, No. (%)9 (7.1)
     Single, No. (%)35 (27.6)
     Separated, No. (%)20 (15.7)
     Widowed, No. (%)15 (11.8)
    Highest education level
     Primary school, No. (%)31 (25.2)
     Secondary school, No. (%)48 (39.0)
     College, No. (%)45 (35.8)
    Place of recruitment
     Inpatient setting, No. (%)38 (29.7)
     Outpatient setting, No. (%)90 (70.3)
    Medications per patient, median (IQR), No.3.0 (2.0–6.0)

    • IQR = interquartile range.

  • Table 2

    Importance of 487 Drugs According to Patients and Physicians

    Physician Rating of ImportanceaPatient Rating of Importanceb
    6 (352 Drugs)5 (76 Drugs)4 (36 Drugs)3 (16 Drugs)2 (1 Drug)1 (6 Drugs)
    0 (10 drugs)8 (1.6)0 (0.0)1 (0.2)0 (0.0)1 (0.2)0 (0.0)
    1 (3 drugs)2 (0.4)1 (0.2)0 (0.0)0 (0.0)0 (0.0)0 (0.0)
    2 (3 drugs)2 (0.4)1 (0.2)0 (0.0)0 (0.0)0 (0.0)0 (0.0)
    3 (11 drugs)7 (1.4)1 (0.2)1 (0.2)1 (0.2)0 (0.0)1 (0.2)
    4 (11 drugs)11 (2.3)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)
    5 (29 drugs)15 (3.1)8 (1.6)4 (0.8)2 (0.4)0 (0.0)0 (0.0)
    6 (48 drugs)35 (7.2)9 (1.8)4 (0.8)0 (0.0)0 (0.0)0 (0.0)
    7 (47 drugs)29 (6.0)8 (1.6)5 (1.0)4 (0.8)0 (0.0)1 (0.2)
    8 (98 drugs)66 (13.6)19 (3.9)10 (2.0)1 (0.2)0 (0.0)2 (0.4)
    9 (59 drugs)48 (9.9)5 (1.0)3 (0.6)2 (0.4)0 (0.0)1 (0.2)
    10 (168 drugs)129 (26.5)24 (4.9)8 (1.6)6 (1.2)0 (0.0)1 (1.0)

    • Note: Values are number (%) of drugs, with a denominator of 487.

    • ↵a Physician scale: 0 = not important; 10 = very important.

    • ↵b Patient scale: 1 = not important, 6 = very important.

  • Table 3

    Patient-Reported Adherence to 498 Drugs and Drug Importance According to Their Physician

    Physician Rating of ImportanceaPatient-Reported Adherence
    High (265 Drugs)Good (46 Drugs)Moderate (77 Drugs)Poor (50 Drugs)Very Poor (39 Drugs)Discontinuation (21 Drugs)
    0 (9 drugs)6 (1.2)0 (0.0)1 (0.2)1 (0.2)1 (0.2)0 (0.0)
    1 (3 drugs)2 (0.4)1 (0.2)0 (0.0)0 (0.0)0 (0.0)0 (0.0)
    2 (3 drugs)1 (0.2)0 (0.0)0 (0.0)0 (0.0)1 (0.2)1 (0.2)
    3 (10 drugs)3 (0.6)0 (0.0)2 (0.4)1 (0.2)0 (0.0)4 (0.8)
    4 (12 drugs)7 (1.4)0 (0.0)2 (0.4)1 (0.2)2 (0.4)0 (0.0)
    5 (28 drugs)19 (3.8)1 (0.2)4 (0.8)3 (0.6)1 (0.2)0 (0.0)
    6 (49 drugs)22 (4.4)7 (1.4)10 (2.0)5 (1.0)3 (0.6)2 (0.4)
    7 (48 drugs)29 (5.8)3 (0.6)3 (0.6)4 (0.8)6 (1.2)3 (0.6)
    8 (98 drug)48 (9.6)11 (2.2)15 (3.0)13 (2.6)7 (1.4)4 (0.8)
    9 (63 drug)33 (6.6)7 (1.4)7 (1.4)10 (2.0)4 (0.8)2 (0.4)
    10 (175 drugs)95 (19.1)16 (3.2)33 (6.6)12 (2.4)14 (2.8)5 (1.0)

    • Note: Values are number (%) of drugs, with a denominator of 498.

    • ↵a Scale: 0 = not important; 10 = very important.

Additional Files

  • Supplemental Appendix, Tables, & Figures

    Supplemental Appendix, Tables 1-3, Figures 1-3

    Files in this Data Supplement:

  • The Article in Brief

    Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians

    Viet-Thi Tran , and colleagues

    Background This study investigates whether patients adhere to drugs considered important by their physicians. For patients under long-term drug treatment, it compares drug adherence self-reported by patients and drug importance according to their usual primary care physician.

    What This Study Found There is substantial discordance between patient-reported drug adherence and physicians' assessment of drug importance with nearly 20 percent of drugs deemed important by physicians not correctly taken by patients. Comparing drug adherence reported by patients and drug importance assessed by physicians, the study found patients reported good adherence for 339 drugs (68 percent) evaluated as important by physicians, but for 94 drugs (19 percent), patients reported poor adherence even though their physicians evaluated them as important. Poor adherence involved mainly heart drugs, oral blood glucose-lowering drugs and insulin, and drugs for airway diseases. Patients intentionally did not adhere to 26 (48 percent) of the drugs for which they reported reasons for non-adherence. Notably, physicians rated 65 drugs (13 percent) as less important to patient health, raising questions about overtreatment and drug appropriateness.

    Implications

    • The authors conclude these findings highlight the need for better patient-physician collaboration in drug treatment, especially for patients having the poorest understanding of their medications and fewer beliefs in the need for medications.

  • Annals Journal Club

    Sep/Oct 2016: Informing a Different Conversation About Medication


    The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1

    HOW IT WORKS

    In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.

    CURRENT SELECTION

    Article for Discussion

    Sidorkiewicz S, Tran V, Cousyn C, Perrodeau E, Ravaud P. Discordance between drug adherence as reported by patients and drug importance as assessed by physicians. Ann Fam Med 2016;14(5):415-421.

    Discussion Tips

    This article provides an unusual opportunity to consider patients' understanding and use of their medications? to consider and convey the relative importance of patients' drugs from a medical point of view, to ask carefully about, rather than assuming, which drugs people are taking and why, and perhaps to work toward shared understanding.

    Discussion Questions

    • What question is asked by this study and why does it matter?
    • How does this study advance beyond previous research and clinical practice on this topic?
    • How strong is the study design for answering the question?
    • To what degree can the findings be accounted for by:
      1. How participating physicians and patients were selected?
      2. How the main variables were measured?
      3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
      4. Chance?
      5. How the findings were interpreted?
    • What are the main study findings ? among patients, among physicians, and particularly around their comparison? (See additional findings in the online appendix.)
    • How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings? How does the mix of inpatient and outpatient samples affect your interpretation of the findings?
    • What contextual factors are important for interpreting the findings?
    • How might this study change your practice? Policy? Education? Research?
    • What different conversations might we have to understand what we now are assuming? Or to share our priorities from a medical point of view and listen to patient's point of view as they live their lives and try to integrate pharmacotherapy? How might we find the sweet spot between these perspectives, and in the process, develop healing relationships that can be called on for issues beyond drug treatment?
    • Who the constituencies are for the findings, and how they might be engaged in interpreting or using the findings?
    • What are the next steps in interpreting or applying the findings?
    • What researchable questions remain?

    References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.

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