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Research ArticleOriginal Research

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Ngaire Kerse, Stephen Buetow, Arch G. Mainous, Gregory Young, Gregor Coster and Bruce Arroll
The Annals of Family Medicine September 2004, 2 (5) 455-461; DOI: https://doi.org/10.1370/afm.139
Ngaire Kerse
PhD, MBChB
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Stephen Buetow
PhD
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Arch G. Mainous III
PhD
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Gregory Young
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Gregor Coster
MSc, MBChB
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Bruce Arroll
PhD, MBChB
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    Figure 1.

    Flow of primary care patients in a study about medication compliance.

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    Table 1.

    Demographic Characteristics of a Sample of Primary Care Patients Gathered in Waiting Rooms (N = 370)

    CharacteristicMean (SD)
    Note: Because of rounding, percentages may not all total 100.
    EuroQol-5D = the EuroQol 5-dimensional questionnaire.
    Age of patients, years41.3 (15.8)
    No. of consultations in last year5.3 (6.7)
    EuroQol-5D score8.0 (2.5)
    No. (%)
    Sex, female247 (68.1)
    Ethnicity
        White276 (74.5)
        Maori46 (12.4)
        Pacific Islander32 (8.6)
        Other16 (4.3)
    Economic status
        Community services card122 (34.2)
        Can’t make ends meet26 (7.0)
        Have just enough144 (38.9)
        Am comfortable189 (51.1)
    Education
        Less than high school77 (22.8)
        Completed high school144 (42.7)
        Some higher qualification116 (34.4)
    Person consulting
        Myself276 (76.2)
        A child I am caring for81 (22.4)
        An adult I am caring for5 (1.4)
    Chronic illness in the patient113 (30.9)
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    Table 2.

    Consultation Characteristics of a Sample of Primary Care Patients Gathered in Waiting Rooms (N = 370)

    CharacteristicValue
    Note: Because of rounding, percentages may not all total 100.
    UPC = Usual Provider Continuity.
    * Responses were missing for 35 patients.
    † Values are based on 172 patients who received a prescription and had follow-up.
    ‡ An additional 8 patients received a repeated prescription and already had enough medication.
    Trust
    Trust in Physician Scale score, mean (SD)44.57 (6.25)
    Source of care
    Has a usual source of care (clinic), No. (%) of patients326 (88.1)
    Has a usual doctor, No. (%) of patients279 (75.4)
    Continuity of care
    UPC Index score, mean (SD)0.75 (0.31)
    Length of care with same doctor, No. (%) of patients
        <1 year82 (24)
        1–2 years56 (16)
        3–5 years69 (20)
        6–10 years49 (14)
        >10 years91 (26)
    Importance of seeing same doctor at each visit, No. (%) of patients
        Very important152 (41.3)
        Quite important150 (40.9)
        Neutral40 (10.9)
        Not very, not important at all26 (8.2)
    Enablement
    Enablement Index score, mean (SD)2.1 (0.75)
    Doctor-patient concordance
    No. (%) of patients responding “completely”*
        To what extent do you think the doctor understands why you came in today?294 (89.1)
        How well do you think the doctor understood you today?293 (88.5)
        To what extent did you and the doctor agree about the main problem or need today?280 (84.5)
        To what extent did you and the doctor agree about what to do about the problem or need?278 (84.2)
        To what extent do you and the doctor agree on what part you play in making decisions about health?241 (73.9)
        To what extent do you and the doctor agree on who is responsible for different aspects of care?239 (74.7)
    Overall score, mean (SD)3.6 (1.9)
    Compliance
    No. (%) of patients responding “yes”
        Received prescription during consultation220 (61.3)
        Picked up prescription from pharmacy†150 (86.7)
        Taking medication†136 (78.6)‡
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    Table 3.

    Relationship Between Consultation Attributes and Compliance With Medications (the Dependent Variable) in Logistic Regression Analysis (N = 172)

    Consultation VariableUnadjusted OR (95% CI)Adjusted* OR (95% CI)
    Note: All analyses are adjusted for clustering.
    OR = odds ratio; CI = confidence interval; UPC = Usual Provider Continuity.
    * Logistic regression adjusted for age, sex, ethnicity, education, perceived financial status, EuroQol 5-dimensional questionnaire (EuroQol-5D) score, and number of visits in the last year.
    † After addition of an interaction term for sex and doctor-patient concordance to the model, OR = 1.74 (95% CI, 1.25–2.43).
    Trust in Physician Scale score1.07 (1.020–1.12)1.04 (0.99–1.10)
    Continuity of care
        UPC Index0.90 (0.97–1.01)0.99 (0.97–1.02)
        Usual source of care2.87 (0.86–9.60)5.98 (1.88–19.03)
        Length of care with same doctor0.94 (0.74–1.19)0.86 (0.68–1.09)
        Importance of seeing same doctor each visit0.86 (0.56–1.30)0.80 (0.51–1.25)
    Enablement Index1.03 (0.99–1.08)1.05 (0.98–1.12)
    Physician-patient concordance score1.21 (1.05–1.39)1.34 (1.04–1.72)†

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    Patients who feel that the doctor understands them and their health problems, and who agree with the doctor about their treatment, are more likely than other patients to take their medications as prescribed. Efforts to make sure that patients and doctors understand each other and reach agreement could have important health benefits.

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The Annals of Family Medicine: 2 (5)
The Annals of Family Medicine: 2 (5)
Vol. 2, Issue 5
1 Sep 2004
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Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation
Ngaire Kerse, Stephen Buetow, Arch G. Mainous, Gregory Young, Gregor Coster, Bruce Arroll
The Annals of Family Medicine Sep 2004, 2 (5) 455-461; DOI: 10.1370/afm.139

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Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation
Ngaire Kerse, Stephen Buetow, Arch G. Mainous, Gregory Young, Gregor Coster, Bruce Arroll
The Annals of Family Medicine Sep 2004, 2 (5) 455-461; DOI: 10.1370/afm.139
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