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Physician Communication When Prescribing New Medications
Derjung M. Tarn, MD, PhD;
John Heritage, PhD;
Debora A. Paterniti, PhD;
Ron D. Hays, PhD;
Richard L. Kravitz, MD, MSPH;
Neil S. Wenger, MD, MPH
Arch Intern Med. 2006;166:1855-1862.
Background Communication about taking a new medication is critical to proper use of drug therapy and to patient adherence. Despite ample evidence that medications are not taken as prescribed, few investigations have detailed the elements of communication about new medication therapy. This article describes and assesses the quality of physician communication with patients about newly prescribed medications.
Methods This was an observational study that combined patient and physician surveys with transcribed audiotaped office visits from 185 outpatient encounters with 16 family physicians, 18 internists, and 11 cardiologists in 2 Sacramento, Calif, health care systems between January and November 1999, in which 243 new medications were prescribed. We measured the quality of physician communication when prescribing new medications.
Results Physicians stated the specific medication name for 74% of new prescriptions and explained the purpose of the medication for 87%. Adverse effects were addressed for 35% of medications and how long to take the medication for 34%. Physicians explicitly instructed 55% of patients about the number of tablets to take and explained the frequency or timing of dosing 58% of the time. Physicians fulfilled a mean of 3.1 of 5 expected elements of communication when initiating new prescriptions. They counseled the most about psychiatric medications, fulfilling a mean of 3.7, 3.5, and 3.4, pulmonary, and cardiovascular elements, respectively.
Conclusions When initiating new medications, physicians often fail to communicate critical elements of medication use. This might contribute to misunderstandings about medication directions or necessity and, in turn, lead to patient failure to take medications as directed.
Author Affiliations: Department of Family Medicine (Dr Tarn) and Division of General Internal Medicine and Health Services Research (Drs Hays and Wenger), David Geffen School of Medicine, University of California, Los Angeles; Department of Sociology, University of California, Los Angeles (Dr Heritage); and UC Davis Center for Health Services Research in Primary Care (Drs Paterniti and Kravitz) and Department of Sociology (Dr Paterniti), University of California–Davis Medical Center, Sacramento.
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