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Howren MB, Christensen AJ, Hillis SL, Walston KA. Patient and Physician Beliefs about Control over Health: Symmetrical Beliefs Predict Medication Regimen Adherence. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 10; Seattle, WA.
Background: Past work suggests that the degree of similarity between patient and physician attitudes may be an important predictor of patient outcomes. Objective: To examine the extent to which patient and provider symmetry in health locus of control (HLOC) beliefs (assessed in parallel for established physician-patient dyads) was associated with objectively-derived medication adherence in patients with co-morbid diabetes mellitus and hypertension. Methods: Eighteen primary care physicians (M age = 47.2 years, SD = 10.6; 56% male) in the VA Iowa City Healthcare System and 246 male patients (M age = 68.8 years, SD = 9.7) of consented providers were surveyed regarding their HLOC beliefs as part of a large study of patient-provider interaction. Medication adherence was computed using VA electronic pharmacy records. Analyses/Results: Physician-patient dyads were classified into three groups according to the similarity of their HLOC scores. Hierarchical linear modeling was used to account for clustering of patients within physicians. After adjustment for age, physician sex, and physician years of practice, dyads holding similar beliefs regarding the degree of personal control that patients have over health outcomes showed significantly higher overall and cardiovascular medication regimen adherence (p's = .03) than in dyads in which the patient held a stronger belief in personal control than did their treating physician. Conclusions: These data are the first to demonstrate the importance of attitudinal symmetry on an objective measure of medication adherence and suggest that a brief assessment of patient HLOC may be useful for tailoring the provider's approach in the clinical encounter or for matching patients with chronic illness to physicians with similar attitudes towards care.
