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Physicians Don't Tell All

September 2006 - 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 25 September 2006 issue of Archives of Internal Medicine.

Drawing on previous research, the report states that almost half of all Americans take at least one prescription drug and half of older adults take three or more. Taking medications properly is essential in ensuring their effectiveness. However, patients often do not adhere to prescribed therapies, which can lead to worsening disease, treatment failure, adverse effects, drug overdose, unnecessary hospitalization and higher health care costs.

The authors comment:

"Patients who report better general physician communication, better explanations about how to take their medications and more medication information are more adherent. One-on-one educational interventions can improve patient adherence and health outcomes."

Derjung Tarn, of the David Geffen School of Medicine, University of California and colleagues assessed communication by 44 physicians prescribing new medications in 185 outpatient visits in 1999. Patients were called one to two days prior to their appointments at one of two health care systems in Sacramento, California. Their encounters with the physicians were then audio-taped 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 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 per cent of the necessary information was conveyed. Physicians used the specific name for 74 per cent of new prescriptions, explained the purpose for 87 per cent and discussed adverse effects for 35 per cent. Instruction on how long to take the drug was included in 34 per cent, the number of tablets to take in 55 per cent and the frequency or timing of dosing in 58 per cent of cases.

The authors say:

"This study demonstrates spotty physician counseling about new medication prescriptions. 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 per cent of all medications and informed patients about duration of intake and adverse effects or adverse events only approximately one-third of the time."

The study concludes that patients receiving incomplete instructions may be less likely to take their medication properly, in part because they do not understand how to do so. 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. The authors call for more research 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.

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