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Robyn Tamblyn, PhD; Michal Abrahamowicz, PhD; Dale Dauphinee, MD; Elizabeth Wenghofer, PhD; André Jacques, MD; Daniel Klass, MD; Sydney Smee, PhD; Tewodros Eguale, MD, MSc; Nancy Winslade, PharmD; Nadyne Girard, MSc; Ilona Bartman, MA; David L. Buckeridge, MD, PhD; James A. Hanley, PhD

Arch Intern Med. 2010;170(12):1064-1072.

Background  Less than 75% of people prescribed antihypertensive medication are still using treatment after 6 months. Physicians determine treatment, educate patients, manage side effects, and influence patient knowledge and motivation. Although physician communication ability likely influences persistence, little is known about the importance of medical management skills, even though these abilities can be enhanced through educational and practice interventions. The purpose of this study was to determine whether a physician's medical management and communication ability influence persistence with antihypertensive treatment.

Methods  This was a population-based study of 13 205 hypertensive patients who started antihypertensive medication prescribed by a cohort of 645 physicians entering practice in Quebec, Canada, between 1993 and 2007. Medical Council of Canada licensing examination scores were used to assess medical management and communication ability. Population-based prescription and medical services databases were used to assess starting therapy, treatment changes, comorbidity, and persistence with antihypertensive treatment in the first 6 months.

Results  Within 6 months after starting treatment, 2926 patients (22.2%) had discontinued all antihypertensive medication. The risk of nonpersistence was reduced for patients who were treated by physicians with better medical management (odds ratio per 2-SD increase in score, 0.74; 95% confidence interval, 0.63-0.87) and communication (0.88; 0.78-1.00) ability and with early therapy changes (odds ratio, 0.45; 95% confidence interval, 0.37-0.54), more follow-up visits, and nondiuretics as the initial choice of therapy. Medical management ability was responsible for preventing 15.8% (95% confidence interval, 7.5%-23.3%) of nonpersistence.

Conclusion  Better clinical decision-making and data collection skills and early modifications in therapy improve persistence with antihypertensive therapy.

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs Tamblyn, Abrahamowicz, Eguale, Winslade, Buckeridge, and Hanley and Ms Girard) and Medicine (Drs Tamblyn and Dauphinee), McGill University, Montreal, Quebec, Canada; School of Rural and Northern Health, Laurentian University and Northern Ontario School of Medicine, Sudbury, Ontario, Canada (Dr Wenghofer); Professional Development, College of Physicians and Surgeons of Ontario, Toronto (Dr Klass); Professional Development, Quebec College of Physicians, Montreal (Dr Jacques); and Medical Council of Canada, Ottawa, Ontario (Dr Smee and Ms Bartman).

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