Communication and Medication Refill Adherence: The Diabetes Study of Northern California | Clinical Pharmacy and Pharmacology | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
American Diabetes Association.  Standards of medical care in diabetes—2012.  Diabetes Care. 2012;35:(suppl 1)  S11-S6322187469PubMedGoogle ScholarCrossref
Kerr EA, Zikmund-Fisher BJ, Klamerus ML, Subramanian U, Hogan MM, Hofer TP. The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure.  Ann Intern Med. 2008;148(10):717-72718490685PubMedGoogle Scholar
Heisler M, Hogan MM, Hofer TP, Schmittdiel JA, Pladevall M, Kerr EA. When more is not better: treatment intensification among hypertensive patients with poor medication adherence.  Circulation. 2008;117(22):2884-289218506011PubMedGoogle ScholarCrossref
Schmittdiel JA, Uratsu CS, Karter AJ,  et al.  Why don't diabetes patients achieve recommended risk factor targets? poor adherence versus lack of treatment intensification.  J Gen Intern Med. 2008;23(5):588-59418317847PubMedGoogle ScholarCrossref
Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV. New prescription medication gaps: a comprehensive measure of adherence to new prescriptions.  Health Serv Res. 2009;44(5 Pt 1):1640-166119500161PubMedGoogle ScholarCrossref
Cooper LA, Roter DL, Carson KA,  et al.  A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients.  J Gen Intern Med. 2011;26(11):1297-130421732195PubMedGoogle ScholarCrossref
Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review.  J Am Board Fam Pract. 2002;15(1):25-3811841136PubMedGoogle Scholar
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis.  Med Care. 2009;47(8):826-83419584762PubMedGoogle ScholarCrossref
Stewart M, Brown JB, Donner A,  et al.  The impact of patient-centered care on outcomes.  J Fam Pract. 2000;49(9):796-80411032203PubMedGoogle Scholar
Institute of Medicine.  Committee on Quality of Health Care in America: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:337
Agency for Healthcare Research and Quality.  CAHPS Clinician & Group 12-Month Survey. Updated 2011. Accessed January 29, 2012
Lin GA, Dudley RA. Patient-centered care: what is the best measuring stick?  Arch Intern Med. 2009;169(17):1551-155319786671PubMedGoogle ScholarCrossref
Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform?  JAMA. 2009;301(19):2038-204019454643PubMedGoogle ScholarCrossref
Heisler M, Cole I, Weir D, Kerr EA, Hayward RA. Does physician communication influence older patients' diabetes self-management and glycemic control? results from the Health and Retirement Study (HRS).  J Gerontol A Biol Sci Med Sci. 2007;62(12):1435-144218166697PubMedGoogle ScholarCrossref
Naik AD, Kallen MA, Walder A, Street RL Jr. Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.  Circulation. 2008;117(11):1361-136818316489PubMedGoogle ScholarCrossref
Schoenthaler A, Allegrante JP, Chaplin W, Ogedegbe G. The effect of patient-provider communication on medication adherence in hypertensive black patients: does race concordance matter?  Ann Behav Med. 2012;43(3):372-38222270266PubMedGoogle ScholarCrossref
Gonzalez JS, Schneider HE. Methodological issues in the assessment of diabetes treatment adherence.  Curr Diab Rep. 2011;11(6):472-47921956675PubMedGoogle ScholarCrossref
Shi L, Liu J, Koleva Y, Fonseca V, Kalsekar A, Pawaskar M. Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices.  Pharmacoeconomics. 2010;28(12):1097-110721080735PubMedGoogle ScholarCrossref
Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The concordance of self-report with other measures of medication adherence: a summary of the literature.  Med Care. 2004;42(7):649-65215213489PubMedGoogle ScholarCrossref
Rand CS, Nides M, Cowles MK, Wise RA, Connett J.The Lung Health Study Research Group.  Long-term metered-dose inhaler adherence in a clinical trial.  Am J Respir Crit Care Med. 1995;152(2):580-5887633711PubMedGoogle ScholarCrossref
Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature.  Diabetes Care. 2000;23(7):934-94210895843PubMedGoogle ScholarCrossref
de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis.  Psychosom Med. 2001;63(4):619-63011485116PubMedGoogle Scholar
Gonzalez JS, Peyrot M, McCarl LA,  et al.  Depression and diabetes treatment nonadherence: a meta-analysis.  Diabetes Care. 2008;31(12):2398-240319033420PubMedGoogle ScholarCrossref
Swanson KA, Bastani R, Rubenstein LV, Meredith LS, Ford DE. Effect of mental health care and shared decision making on patient satisfaction in a community sample of patients with depression.  Med Care Res Rev. 2007;64(4):416-43017684110PubMedGoogle ScholarCrossref
Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures.  Arch Intern Med. 2005;165(15):1749-175516087823PubMedGoogle ScholarCrossref
Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus.  Am J Med. 2005;118:(suppl 5A)  27S-34S15850551PubMedGoogle ScholarCrossref
Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes.  Diabetes Care. 2003;26(5):1408-141212716797PubMedGoogle ScholarCrossref
Moffet HH, Adler N, Schillinger D,  et al.  Cohort Profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population.  Int J Epidemiol. 2009;38(1):38-4718326513PubMedGoogle ScholarCrossref
Stewart AL, Nápoles-Springer AM, Gregorich SE, Santoyo-Olsson J. Interpersonal processes of care survey: patient-reported measures for diverse groups.  Health Serv Res. 2007;42(3, pt 1):1235-125617489912PubMedGoogle ScholarCrossref
Thom DH, Ribisl KM, Stewart AL, Luke DA.The Stanford Trust Study Physicians.  Further validation and reliability testing of the Trust in Physician Scale.  Med Care. 1999;37(5):510-51710335753PubMedGoogle ScholarCrossref
Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships.  Psychol Rep. 1990;67(3, pt 2):1091-11002084735PubMedGoogle ScholarCrossref
Morales LS, Elliott MN, Weech-Maldonado R, Spritzer KL, Hays RD. Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0.  Health Serv Res. 2001;36(3):595-61711482591PubMedGoogle Scholar
Fongwa MN, Cunningham W, Weech-Maldonado R, Gutierrez PR, Hays RD. Reports and ratings of care: black and white Medicare enrollees.  J Health Care Poor Underserved. 2008;19(4):1136-114719029741PubMedGoogle ScholarCrossref
Hays RD, Shaul JA, Williams VS,  et al.  Psychometric properties of the CAHPS 1.0 survey measures: Consumer Assessment of Health Plans Study.  Med Care. 1999;37(3):(suppl)  MS22-MS3110098556PubMedGoogle ScholarCrossref
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications.  J Clin Epidemiol. 1997;50(1):105-1169048695PubMedGoogle ScholarCrossref
Steiner JF, Koepsell TD, Fihn SD, Inui TS. A general method of compliance assessment using centralized pharmacy records: description and validation.  Med Care. 1988;26(8):814-8233398608PubMedGoogle ScholarCrossref
Bryson CL, Au DH, Young B, McDonell MB, Fihn SD. A refill adherence algorithm for multiple short intervals to estimate refill compliance (ReComp).  Med Care. 2007;45(6):497-50417515776PubMedGoogle ScholarCrossref
Fernandez A, Schillinger D, Warton EM,  et al.  Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE).  J Gen Intern Med. 2011;26(2):170-17620878497PubMedGoogle ScholarCrossref
Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension.  J Gen Intern Med. 2005;20(9):800-80616117746PubMedGoogle ScholarCrossref
Fernandez A, Schillinger D, Grumbach K,  et al.  Physician language ability and cultural competence: an exploratory study of communication with Spanish-speaking patients.  J Gen Intern Med. 2004;19(2):167-17415009796PubMedGoogle ScholarCrossref
Sarkar U, Karter AJ, Liu JY, Moffet HH, Adler NE, Schillinger D. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE).  J Gen Intern Med. 2010;25(9):962-96820480249PubMedGoogle ScholarCrossref
Chew LD, Griffin JM, Partin MR,  et al.  Validation of screening questions for limited health literacy in a large VA outpatient population.  J Gen Intern Med. 2008;23(5):561-56618335281PubMedGoogle ScholarCrossref
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure.  J Gen Intern Med. 2001;16(9):606-61311556941PubMedGoogle ScholarCrossref
Peyrot M, Rubin RR. Structure and correlates of diabetes-specific locus of control.  Diabetes Care. 1994;17(9):994-10017988321PubMedGoogle ScholarCrossref
Benet-Martínez V, John OP. Los Cinco Grandes across cultures and ethnic groups: multitrait multimethod analyses of the Big Five in Spanish and English.  J Pers Soc Psychol. 1998;75(3):729-7509781409PubMedGoogle ScholarCrossref
Srivastava S, John OP, Gosling SD, Potter J. Development of personality in early and middle adulthood: set like plaster or persistent change?  J Pers Soc Psychol. 2003;84(5):1041-105312757147PubMedGoogle ScholarCrossref
Gosling SD, Rentfrow PJ, Swann WB. A very brief measure of the big-five personality domains.  J Res Pers. 2003;37(6):504-528Google ScholarCrossref
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index.  J Clin Epidemiol. 1994;47(11):1245-12517722560PubMedGoogle ScholarCrossref
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.  J Clin Epidemiol. 1992;45(6):613-6191607900PubMedGoogle ScholarCrossref
Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research.  Epidemiology. 1999;10(1):37-489888278PubMedGoogle ScholarCrossref
Hernán MA, Hernández-Díaz S, Werler MM, Mitchell AA. Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology.  Am J Epidemiol. 2002;155(2):176-18411790682PubMedGoogle ScholarCrossref
Osterberg L, Blaschke T. Adherence to medication.  N Engl J Med. 2005;353(5):487-49716079372PubMedGoogle ScholarCrossref
Kripalani S, Gatti ME, Jacobson TA. Association of age, health literacy, and medication management strategies with cardiovascular medication adherence.  Patient Educ Couns. 2010;81(2):177-18120684870PubMedGoogle ScholarCrossref
Yang Y, Thumula V, Pace PF, Banahan BF III, Wilkin NE, Lobb WB. Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: a retrospective cohort study.  Clin Ther. 2009;31(10):2178-218819922889PubMedGoogle ScholarCrossref
Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention.  Cardiovasc Drugs Ther. 2007;21(4):311-31617665294PubMedGoogle ScholarCrossref
Wolf MS, Davis TC, Osborn CY, Skripkauskas S, Bennett CL, Makoul G. Literacy, self-efficacy, and HIV medication adherence.  Patient Educ Couns. 2007;65(2):253-26017118617PubMedGoogle ScholarCrossref
Christensen AJ, Howren MB, Hillis SL,  et al.  Patient and physician beliefs about control over health: association of symmetrical beliefs with medication regimen adherence.  J Gen Intern Med. 2010;25(5):397-40220174972PubMedGoogle ScholarCrossref
Roumie CL, Greevy R, Wallston KA,  et al.  Patient centered primary care is associated with patient hypertension medication adherence.  J Behav Med. 2011;34(4):244-25321161578PubMedGoogle ScholarCrossref
DiMatteo MR, Haskard KB, Williams SL. Health beliefs, disease severity, and patient adherence: a meta-analysis.  Med Care. 2007;45(6):521-52817515779PubMedGoogle ScholarCrossref
DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research.  Med Care. 2004;42(3):200-20915076819PubMedGoogle ScholarCrossref
Horvitz DG, Thompson DJ. A generalization of sampling without replacement from a finite universe.  J Am Stat Assoc. 1952;47(260):663-685Google ScholarCrossref
Cheung YB. A modified least-squares regression approach to the estimation of risk difference.  Am J Epidemiol. 2007;166(11):1337-134418000021PubMedGoogle ScholarCrossref
Zou G. A modified Poisson regression approach to prospective studies with binary data.  Am J Epidemiol. 2004;159(7):702-70615033648PubMedGoogle ScholarCrossref
Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter?  J Gen Intern Med. 2010;25(11):1172-117720571929PubMedGoogle ScholarCrossref
Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?  J Gen Intern Med. 2006;21(6):661-66516808754PubMedGoogle ScholarCrossref
Saha S, Jacobs EA, Moore RD, Beach MC. Trust in physicians and racial disparities in HIV care.  AIDS Patient Care STDS. 2010;24(7):415-42020578909PubMedGoogle ScholarCrossref
Karter AJ, Subramanian U, Saha C,  et al.  Barriers to insulin initiation: the translating research into action for diabetes insulin starts project.  Diabetes Care. 2010;33(4):733-73520086256PubMedGoogle ScholarCrossref
Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice.  Clin Ther. 1999;21(6):1074-109010440628PubMedGoogle ScholarCrossref
Grant RW, Pabon-Nau L, Ross KM, Youatt EJ, Pandiscio JC, Park ER. Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines.  Diabetes Educ. 2011;37(1):78-8421115980PubMedGoogle ScholarCrossref
Ho PM, Magid DJ, Masoudi FA, McClure DL, Rumsfeld JS. Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease.  BMC Cardiovasc Disord. 2006;6:4817173679PubMedGoogle ScholarCrossref
Lee YY, Lin JL. The effects of trust in physician on self-efficacy, adherence and diabetes outcomes.  Soc Sci Med. 2009;68(6):1060-106819162386PubMedGoogle ScholarCrossref
Gonzales R, Handley MA. Improving glycemic control when “usual” diabetes care is not enough.  Arch Intern Med. 2011;171(22):1999-200021986349PubMedGoogle ScholarCrossref
Naik AD, Palmer N, Petersen NJ,  et al.  Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial.  Arch Intern Med. 2011;171(5):453-45921403042PubMedGoogle ScholarCrossref
Schillinger D, Handley M, Wang F, Hammer H. Effects of self-management support on structure, process, and outcomes among vulnerable patients with diabetes: a three-arm practical clinical trial.  Diabetes Care. 2009;32(4):559-56619131469PubMedGoogle ScholarCrossref
Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report.  Patient Educ Couns. 2009;76(2):174-18019560895PubMedGoogle ScholarCrossref
Bieszk N, Patel R, Heaberlin A, Wlasuk K, Zarowitz B. Detection of medication nonadherence through review of pharmacy claims data.  Am J Health Syst Pharm. 2003;60(4):360-36612625218PubMedGoogle Scholar
Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP. Misunderstandings in prescribing decisions in general practice: qualitative study.  BMJ. 2000;320(7233):484-48810678863PubMedGoogle ScholarCrossref
Ratanawongsa N, Crosson JC, Schillinger D, Karter AJ, Saha CK, Marrero DG. Getting under the skin of clinical inertia in insulin initiation: the Translating Research Into Action for Diabetes (TRIAD) Insulin Starts Project.  Diabetes Educ. 2012;38(1):94-10022222513PubMedGoogle ScholarCrossref
Ratanawongsa N, Wright SM, Vargo EM, Carrese JA. Challenges in primary care relationships: seeing it from both sides.  Patient Educ Couns. 2011;85(1):40-4520828976PubMedGoogle ScholarCrossref
Bezreh T, Laws MB, Taubin T, Rifkin DE, Wilson IB. Challenges to physician-patient communication about medication use: a window into the skeptical patient's world.  Patient Prefer Adherence. 2012;6:11-1822272065PubMedGoogle Scholar
Kocher R, Emanuel EJ, DeParle NA. The Affordable Care Act and the future of clinical medicine: the opportunities and challenges.  Ann Intern Med. 2010;153(8):536-53920733178PubMedGoogle Scholar
Galliher JM, Post DM, Weiss BD,  et al.  Patients' question-asking behavior during primary care visits: a report from the AAFP National Research Network.  Ann Fam Med. 2010;8(2):151-15920212302PubMedGoogle ScholarCrossref
Original Investigation
February 11, 2013

Communication and Medication Refill Adherence: The Diabetes Study of Northern California

Author Affiliations

Author Affiliations: General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco (UCSF) (Drs Ratanawongsa, Lyles, and Schillinger); Division of Research, Kaiser Permanente, Oakland, California (Dr Karter, Mss Parker and Warton, and Mr Moffet); Department of Epidemiology, School of Public Health & Community Health, University of Washington, Seattle (Dr Karter); Center for Clinical Management Research, Health Services Research and Development (HRS&D) Center of Excellence, VA Ann Arbor Healthcare System, and Departments of Internal Medicine and Health Behavior and Health Education, University of Michigan, Ann Arbor (Dr Heisler); UCSF Center for Health and Community, San Francisco (Dr Adler); and California Diabetes Program, California Department of Public Health, Sacramento (Dr Schillinger).

JAMA Intern Med. 2013;173(3):210-218. doi:10.1001/jamainternmed.2013.1216

Background Poor medication refill adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking communication between patients and health care providers to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications.

Methods To investigate associations between patient communication ratings and cardiometabolic medication refill adherence, we conducted a cross-sectional analysis of 9377 patients in the Diabetes Study of Northern California (DISTANCE), a race-stratified, random sample of Kaiser Permanente survey respondents. Eligible participants received 1 or more oral hypoglycemic, lipid-lowering, or antihypertensive medication in the 12 months preceding the survey. Communication was measured with a 4-item Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) score and 4 items from the Trust in Physicians and Interpersonal Processes of Care instruments. Poor adherence was classified as greater than a 20% continuous medication gap for ongoing medication therapies. Using modified least squares regression, we calculated differences in poor adherence prevalence for a 10-point decrease in CAHPS score and compared higher vs lower communication ratings on other items, adjusting for necessary sociodemographic and medical confounders derived from a directed acyclic graph.

Results In this cohort, 30% had poor cardiometabolic medication refill adherence. For each 10-point decrease in CAHPS score, the adjusted prevalence of poor adherence increased by 0.9% (P = .01). Compared with patients offering higher ratings, patients who gave health care providers lower ratings for involving patients in decisions, understanding patients' problems with treatment, and eliciting confidence and trust were more likely to have poor adherence, with absolute differences of 4% (P = .04), 5% (P = .02), and 6% (P = .03), respectively. Associations between communication and adherence were somewhat larger for hypoglycemic medications than for other medications.

Conclusions Poor communication ratings were independently associated with objectively measured inadequate cardiometabolic medication refill adherence, particularly for oral hypoglycemic medications. Future studies should investigate whether improving communication skills among clinicians with poorer patient communication ratings could improve their patients' cardiometabolic medication refill adherence and outcomes.