Background: Non-adherence to medication increases patient’s risk of morbidity, mortality and economic wastage of scare medical resources. This study was conducted to assess the role of doctor-patient communication and duration of consultation, as tools to improve adherence to hypertension treatment.

Methods: Data of this cross-sectional study were collected by face to face interview and document reviewat Combined Military Hospital (CMH), Dhaka among 253 conveniently recruited hypertensive patients attending Out Patient Department between July 2016 to June 2017. Mean-age of the respondents was 49.2 (±10.4) years, mostly married male (54.9% male, 95.3% married). Mean consultation duration experienced by the respondents was 5.3 (± 1.3) minutes. Among the participants, 63.64% experienced effective communication, 66% were adherent and 34% were non-adherent to medication. Among the respondents with effective communication, 92.5% were adherent to medication. On the contrary, among the respondents with ineffective communication, 80.4% were non-adherent.

Results: Duration of consultation had significant statistical association with adherence to hypertension treatment (p<0.001). Association between communication and adherence to medication was highly significant (p<0.001). Binary Logistic Regression revealed that respondents were 3.23 times more adherent to medication with favorable response to the item- ‘Doctor gave me as much information as I wanted’ (p = 0.041); and 10.24 times with favorable response to the item- ‘Doctor checked to be sure that I understood everything’(p=0.006). Patient’s faithfulness in carrying out prescription and proscriptions correctly depends on the adequacy and accuracy of patient’s knowledge of what they were supposed to do and on their motivation.

Conclusion: Thus, it is necessary to formulate interventions to scale up communication skill of the physicians, and devise effective ways to educate patients on medication of chronic diseases. Further studies on characteristics of consultation to make it motivating and more effective may be conducted.

Keywords: Treatment adherence, Medication compliance, Doctor-patient communication

Jump to Section -------------------- Top of Page Abstract Introduction Materials and Methods Results Discussion References

Introduction

Hypertension is a condition with a tremendous economic and public health impact which contributes to disability, health care costs and mortality.¹ It affects up to 37% of global adult population and is estimated that 7.1 million deaths are due to hypertension.² Although the management and control of hypertension reduces morbidity and mortality, paradoxically the percentage of patients with controlled hypertension has been reported to vary between 5.4% and 58% only worldwide.³

One of the major causes of this global hypertension threat is failure to take medication as advised. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems. In developing countries, when taken together with poor access to health care, lack of appropriate diagnosis and limited access to medicines, poor adherence is threatening to render futile any effort to tackle chronic conditions, such as diabetes, depression, hypertension, TB and HIV/AIDS.²

It is axiomatic that effective care of patients requires both technical expertise – that is diagnosis and treatment, and interpersonal or psychosocial skill. The latter comprise the physician-patient relationship, patient education, counseling and the caring function. The psychosocial components are particularly important in the outdoor management of patients with chronic diseases because effectiveness of treatment for conditions like hypertension, diabetes mellitus and heart diseases depends largely on patients faithfulness in carrying out instructions correctly.⁴ Nikita Sabherwal et al in Delhi, India, found 62% of the patients had experienced ineffective communication by the doctor.⁵ Various study findings clearly emphasize its abysmal lack in practice and the over-reaching need for the doctors to establish effective communication with the patients. Findings across 106 studies in a meta-analysis by Haskard-Zolnierek K et al the association between physician communication and patient adherence is positive and significant p< .001.⁶

The WHO defines adherence as ‘‘the extent to which the persons behavior (Including medication-taking) corresponds with agreed recommendations from a healthcare provider’’.⁷ It includes the initiation of the treatment, implementation of the prescribed regime, and discontinuation of the pharmacotherapy. It is noted that the adherence rate of less than 75% with short-acting anti-hypertensive drugs increase the risk of cardio-vascular complications.⁸ Donald E Morisky et al in a study found 32.1% low adherers, 52.0% medium adherers, and only 15.9% high adherers.⁹

Except a qualitative study on communication skill of intern-doctors by Rahman A no other study could be found in the context of Bangladesh; exposing a gap in knowledge of communication skill of service providers in Bangladesh.¹⁰ There are a number of factors that predict patient adherence to treatment, but only the relationship between doctor-patient communication and adherence to treatment has beenfocused in this study. The objective of this study is to determine the link between doctor-patient communication, and adherence to anti-hypertensive treatment. Thus, this study will help to identify weaknesses and strengths in communication skills of the physicians with the patient, its relation to adherence to treatment, and potential areas for further improvement.

---