Discussions of Adherence in Medical Interactions: Communication Between Physicians and Older Patients
Developing health-promoting habits and adhering to prescribed treatments are critical components in the management of one's health. However, patient adherence is a challenging process that is affected by a variety of factors, including communication between the healthcare provider and patient. The objective of this study was to develop a reliable and valid rating scale, called the Discussions of Adherence in Medical Interactions Scale (DAMIS), to assess physician-patient communication regarding adherence. Four judges used the DAMIS to rate 135 audiotaped primary care interactions between 73 physicians and their 135 patients aged 60 and older. The DAMIS was shown to have adequate interrater reliability, and the DAMIS composites (physician communication, patient involvement, facilitators of adherence, and barriers to adherence) demonstrated good internal consistency reliability. The DAMIS was also shown to have excellent convergent validity due to its large correlations with another observer-rated measure of physician-patient communication, the Bayer Global Rating Scale (Haskard et al., 2008). Further evidence of validity was provided by the correlations between the DAMIS composites and patient satisfaction with decision-making and choice in the medical visits. As expected, when patients were more involved in the interaction, physicians reported being more satisfied with the patient and with their relationship. More discussion about facilitators of adherence was associated with greater physician satisfaction, whereas more discussion about barriers to adherence was associated with less physician satisfaction. Although the DAMIS composites were not significantly correlated with self-report measures of patient adherence, a regression analysis revealed that more patient involvement was associated with greater medication adherence over the past week, controlling for the other DAMIS composites and patient demographics. Physician-level analyses revealed that female physicians were more likely than male physicians to discuss barriers to adherence with their patients, and near-significant correlations suggest that older and more experienced physicians may be relatively less effective at communicating with patients. However, DAMIS scores did not differ based on physician attitudes (i.e., satisfaction with practice, quality of life, and stress), physician ethnicity, or aspects of their professional training. Strengths and limitations of the study, as well as clinical implications, are discussed.