Physicians prescribing new medication often do not communicate to patients important details, such as potential side effects, how long or how often to take the drug or the specific name of the medication, according to an article in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Almost half of all Americans take at least one prescription drug, and half of older adults take three or more, according to background information in the article. Taking medications properly is essential in ensuring their effectiveness. However, patients often do not adhere to prescribed therapies, which can lead to worsening disease, failure of the treatment, adverse effects, drug overdose, unnecessary hospitalization and higher health care costs. "Patients who report better general physician communication, better explanations about how to take their medications and more medication information are more adherent," the authors write. "One-on-one educational interventions can improve patient adherence and health outcomes."
Derjung M. Tarn, M.D., Ph.D., of the David Geffen School of Medicine, University of California, Los Angeles, and colleagues assessed communication by physicians prescribing new medications in 185 outpatient visits with 44 physicians in 1999. Patients were called one to two days prior to their appointments at one of two health care systems in Sacramento, Calif. Their encounters with the physicians were then audiotaped and transcribed, and physicians identified those at which new medications were prescribed. The researchers coded the transcripts for the type of communication that occurred, based on five key recommended elements: the name of the medication, the purpose or justification for taking it, the duration of use, adverse effects and the number of tablets or sprays plus the frequency or timing of ingestion.
A total of 243 new medications were prescribed at visits monitored during the study, including 46 cardiovascular medications; 42 ear, nose and throat preparations; 35 analgesics (pain-relieving drugs); 35 antibiotics; 21 dermatologic creams; 21 psychiatric medications; and 11 pulmonary medications. Overall, physicians communicated an average of 3.1 of the five essential elements, indicating that 62 percent of the necessary information was conveyed. Physicians used the specific name for 74 percent of new prescriptions, explained the purpose for 87 percent and discussed adverse effects for 35 percent. Thirty-four percent of the encounters included instructions on how long to take the drug, 55 percent on the number of tablets to take and 58 percent on the frequency or timing of dosing.
"This study demonstrates spotty physician counseling about new medication prescriptions," the authors write. "Although physicians educated patients more about psychiatric and analgesic medications, the overall quality of communication was poor even for these medication types and could contribute to patient misunderstandings about how and why to take their new medications. Physicians conveyed full medication dosing directions for less than 60 percent of all medications and informed patients about duration of intake and adverse effects or adverse events only approximately one-third of the time."
Patients receiving incomplete instructions may be less likely to take their medication properly, in part because they do not understand how to do so, they conclude. However, patients often get medication information from pharmacists and other sources, and there may be trade-offs involved to asking physicians to provide more detailed communication. "More research is needed to investigate how much time physicians spend educating patients about new medications and whether better communication is associated with more appropriate patient medication use and health outcomes," they write.
(Arch Intern Med. 2006;166:1855-1862. Available pre-embargo to the media at www.jamamedia.org.)
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