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Gordon HS, Street RL, Deswal AD. Factors associated with adherence to physicians recommendations in a prospective cohort after hospitalization with heart failure. Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 6; Phoenix, AZ.
BACKGROUND: The contribution of physician-patient communication in adherence to physicians' recommendations in patients with heart failure is poorly studied. METHODS: In a prospective observational cohort study of patients hospitalized for an exacerbation of heart failure at 2 large VA Medical Centers, we examined the association of demographic factors, clinical factors and physician-patient communication (ratings and behaviors) with adherence for 210 patients who had scheduled outpatient visits with 93 physicians in the 6 months post-hospital follow-up period. Patients with dementia and terminal illness were excluded. Patients completed questionnaires to collect demographics, functional status, trust, and ratings of communication. Clinical data were abstracted from medical records. Communication behaviors were collected and coded from audio-recordings of the physician-patient visits. Adherence questionnaires were administered by telephone 3-4 weeks after the outpatient visits. Analyses comparing adherence with potential covariates used the chi-square test or t-test as appropriate. Mixed multiple linear regression with a repeated measures design was used to examine the independent relationship of communication and potential co-variates with adherence. RESULTS: Adherence was not statistically different by race, ethnicity, marital status, education, income, employment status, ejection fraction, history of myocardial infarction or diabetes, P > 0.10; but adherence was higher for patients at increased age, P = 0.04, higher functional status, P = 0.001 and was higher (P < .01) for patients reporting higher trust in physician, higher self-efficacy to communicate, and who rated the physician as more informative and more supportive. Adherence was higher for patients whose physicians more frequently used partnering and supportive communication behaviors (P = .02, and P = .001), but not with the overall provision of information (P = .65). Using mixed multiple linear regression to examine the independent association of adherence with communication and potential covariates, demographic and clinical factors were not associated with adherence, but higher patients' rating of the doctor as informative and the doctors more frequent use of supportive communication behaviors were significant predictors of better adherence (P = .04, and P = 0.01). CONCLUSION: In this cohort of heart failure patients, adherence was associated with age, functional status, trust, and both patients' ratings and observers' coding of physicians' communication behaviors. In multiple regression analyses, physicians' supportive communication behavior and the patients' rating of the physician as informative were associated with adherence. Fortunately communication is a skill that can be taught. Future research should evaluate whether training physicians to improve communication can lead to improved adherence.
