Communication training improves physicians’ ability to detect medication nonadherance

This study determined the impact of a communication skills training program on physician communication and ability to detect and address nonadherence in glaucoma patients.

During the study's first phase, the authors conducted sociolinguistic analysis of videotaped encounters of 23 community ophthalmologists with 50 glaucoma patients. Physicians knew during the first phase that communication was being studied but not the exact focus of the study. Afterward, they took part in an educational program designed to teach patient-centered communication skills that included videotaped vignettes of simulated patient encounters and role play. Skills taught included adherence assessment designed to overcome patient resistance to acknowledging nonadherence and the use of open-ended questions in ask-tell-ask sequences to create patient-centered communication eliciting the patients' treatment experience and understanding and concerns about their illness. During the study's second phase, the physicians were videotaped interacting with another 50 glaucoma patients.

Baseline observation demonstrated that ophthalmologists' communication is physician-centered, relying on closed-ended questions that do not permit patients to discuss their experience with treatment or understanding and concerns about their disease. After the educational intervention, physicians doubled the number of questions asked and the number and proportion of open-ended questions. They also frequently made destigmatizing statements about nonadherence. They engaged in substantive discussion of adherence during most encounters after training (82 percent vs. 30 percent before training), and substantially increased discussion of specific barriers and barrier-specific interventions to adherence. They increased their time spent with each patient by 1.9 minutes. Physicians elicited acknowledgement of nonadherance in78 percent of patients who acknowledged nonadherence in the postvisit research interview, compared with 25 percent of patients during the study's initial phase (P = 0.03).

The study demonstrates that experienced community physicians significantly improved their communication strategies and ability to detect and address nonadherence after a three-hour educational program and with only a modest increase in the length of the time spent with each patient.