Skip to main content
Log in

Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Context

Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006.

Objective

To determine the prevalence of physician–patient dialogue about medication cost and medication adherence among elderly adults nationwide.

Design

Cross-sectional survey.

Participants

National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older.

Main Outcome Measures

Rates of physician–patient dialogue about nonadherence and cost-related medication switching.

Results

Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28–5.93, P < .001).

Conclusions

We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson GF. Medicare and chronic conditions. N Engl J Med. 2005;353(3):305–9.

    Article  PubMed  CAS  Google Scholar 

  2. Pear R. 17 Percent Increase in Prescription Drug Costs Hit Elderly Hardest, Study Finds. New York: The New York Times; 27 Jun 2000.

    Google Scholar 

  3. Strunk BC, Ginsburg PB, Gabel JR. Tracking health care costs. Health Aff. 2002;suppl:W39–W50.

    Google Scholar 

  4. Gross DJ, Schondelmeyer SW, Raetzman SO. Trends in manufacturer prices of brand name prescription drugs used by older Americans—first quarter 2004 update. Issue Brief (Public Policy Inst (Am Assoc Retired Pers)) 2004;(IB69):1–2.

  5. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.

    Article  PubMed  Google Scholar 

  6. Higashi T, Shekelle PG, Solomon DH, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004;140(9):714–20.

    PubMed  Google Scholar 

  7. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004;164(3):305–12.

    Article  PubMed  Google Scholar 

  8. Zhan C, Correa-de-Araujo R, Bierman AS, et al. Suboptimal prescribing in elderly outpatients: potentially harmful drug–drug and drug–disease combinations. J Am Geriatr Soc. 2005;53(2):262–7.

    Article  PubMed  Google Scholar 

  9. Steinman MA, Sands LP, Covinsky KE. Self-restriction of medications due to cost in seniors without prescription coverage. J Gen Intern Med. 2001;16:793–9.

    Article  PubMed  CAS  Google Scholar 

  10. Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: How well are states closing the gap. Health Aff (Millwood). 2002;W253–67.

  11. Piette JD, Heisler M, Wagner TH. Cost-related medication underuse among chronically III adults: the treatments people forgo, how often, and who is at risk. Am J Public Health. 2004;94(10):1782–7.

    Article  PubMed  Google Scholar 

  12. Wilson IB, Rogers WH, Chang H, Safran DG. Cost-related skipping of medications and other treatments among Medicare beneficiaries between 1998 and 2000. Results of a national study. J Gen Intern Med. 2005;20(8):715–20.

    Article  PubMed  Google Scholar 

  13. Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004;164(16):1749–55.

    Article  PubMed  Google Scholar 

  14. Alexander GC, Casalino LP, Meltzer DO. Patient–physician communication about out-of-pocket costs. JAMA. 2003;290(7):953–8.

    Article  PubMed  Google Scholar 

  15. Mays J, Brenner M, NeumanT CJCG. Estimates of Medicare Beneficiaries’ Out-of-pocket Drug Spending in 2006 (# 7201). Menlo Park, USA: Kaiser Family Foundation; 24 Nov 2004.

    Google Scholar 

  16. Kaiser Family Foundation. The Kaiser Family Foundation Health Poll Report Survey: Findings on the New Medicare Drug Law. Menlo Park, USA: Kaiser Family Foundation; 2005.

    Google Scholar 

  17. Kaiser Family Foundation. Seniors’ Early Experiences with the Medicare Prescription Drug Benefit—April 2006 (# 7501). Menlo Park, USA: Kaiser Family Foundation; 25 Apr 2006.

    Google Scholar 

  18. Dillman DA. Mail and Telephone Surveys: the Total Design Method. New York: John Wiley & Sons; 1978.

    Google Scholar 

  19. Fowles JB, Fowler EJ, Craft C. Validation of claims diagnoses and self-reported conditions compared with medical records for selected chronic diseases. J Ambul Care Manage. 1998;21(1):24–34.

    PubMed  CAS  Google Scholar 

  20. Buck SF. A method of estimation of missing values in multivariate data suitable for use with an electronic computer. J R Stat Soc. 1960;B22:302–6.

    Google Scholar 

  21. Rogers WH, Qian S, Kazis L. Imputing PCS and MCS in the Presence of Missing Data. Bedford, MA: Center for Health Quality, Outcomes, and Economic Research; 2003.

  22. Jones MP. Indicator and stratification methods for missing explanatory variables in multiple linear regression. J Am Stat Assoc. 1996;91:222–30.

    Article  Google Scholar 

  23. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348(16):1556–64.

    Article  PubMed  Google Scholar 

  24. Weingart SN, Gandhi TK, Seger AC, et al. Patient-reported medication symptoms in primary care. Arch Intern Med. 2005;165(2):234–40.

    Article  PubMed  Google Scholar 

  25. Safran DG, Neuman P, Schoen C, et al. Prescription Drug Coverage and Seniors: Findings From A 2003 National Survey. Health Aff (Millwood). 2005;24W5.152–66

  26. Andersson K, Sonesson C, Petzold M, Carlsten A, Lonnroth K. What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden. Pharmacoepidemiol Drug Saf. 2005;14(5):341–8.

    Article  PubMed  Google Scholar 

  27. Bradley CP, Riaz A, Tobias RS, Kenkre JE, Dassu DY. Patient attitudes to over-the-counter drugs and possible professional responses to self-medication. Fam Pract. 1998;15(1):44–50.

    Article  PubMed  CAS  Google Scholar 

  28. Brennan TA, Lee TH. Allergic to generics. Ann Intern Med. 2004;141(2):126–30.

    PubMed  Google Scholar 

  29. U.S. Food and Drug Administration. FDA Assures Equivalence of Generic Drugs. USA: FDA; 2002.

    Google Scholar 

  30. Van Wijk BL, Klungel OH, Heerdink ER, de BA. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39(2):319–28.

    Article  PubMed  Google Scholar 

  31. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging. 2003;20(11):817–32.

    Article  PubMed  Google Scholar 

  32. Beney J, Bero LA, Bond C. Expanding the roles of outpatientpharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev. 2000;(3):CD000336.

  33. Avorn J. Part “D” for “defective”—the Medicare drug–benefit chaos. N Engl J Med. 2006;354(13):1339–41.

    Article  PubMed  CAS  Google Scholar 

  34. Kaiser Family Foundation. The Transition of Dual Eligibles to Medicare Part D Prescription Drug Coverage (7467). Menlo Park, USA: Kaiser Family Foundation; 28 Feb 2006.

    Google Scholar 

  35. Pear R. Medicare Woes Take High Toll on Mentally Ill. New York: New York Times (online); 21 Jan 2006.

    Google Scholar 

  36. Berenson A. Drug Plan’s Side Effect is Severe. New York: New York Times (online); 8 Apr 2006.

    Google Scholar 

Download references

Acknowledgments

This research was supported the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The authors gratefully acknowledge Spike Duzor, Maribel Franey, and Dural Suite (CMS) for their assistance with the authors’ data request. The contents of this paper are the sole responsibility of the authors and do not necessarily represent the views of the Commonwealth Fund, the Henry J. Kaiser Family Foundation, or Tufts–New England Medical Center.

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ira B. Wilson.

Appendix

Appendix

Medication adherence items (response options for 2–8 were yes, often; yes, sometimes; and no, never).

  1. 1.

    During the last 12 months, how many times did you decide not to fill a prescription because it was too expensive? Response options were none, 1 time, 2 times, 3–4 times, 5–9 times, 10 or more times.

  2. 2.

    During the last 12 months, have you skipped doses of a medicine to make the prescription last longer?

  3. 3.

    During the last 12 months, have you taken a smaller dose of medicine so that the prescription would last longer (for example, by cutting pills in half)

  4. 4.

    During the last 12 months, have you spent less on food, heat, or other basic needs so that you would have enough money for your medicines?

  5. 5.

    During the last 12 months, did you decide not to fill a prescription because you felt you were taking too many medications?

  6. 6.

    During the last 12 months, did you decide not to fill a prescription because you didn’t think you needed the medicine?

  7. 7.

    During the last 12 months, have you skipped doses or stopped taking a medicine because it was making you feel worse?

  8. 8.

    During the last 12 months, have you skipped doses or stopped taking a medicine because you didn’t think it was helping you?

Physician–patient dialogue items (response options were yes and no).

  1. 1.

    During the last 12 months, did your personal doctor talk with you about all of the different medicines you are using, including medicines prescribed by other doctors?

  2. 2.

    During the last 12 months, did you talk with any of your doctors about the cost of your prescription medicines?

  3. 3.

    During the last 12 months, did you talk with any of your doctors about changing one of your prescription medicines because the medicine was making you feel worse or was not working?

  4. 4.

    During the last 12 months, did any of your doctors switch you from one prescription medicine to a different one that would cost you less?

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilson, I.B., Schoen, C., Neuman, P. et al. Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors. J GEN INTERN MED 22, 6–12 (2007). https://doi.org/10.1007/s11606-006-0093-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-006-0093-0

Key words

Navigation