Patient–provider communication and diabetes medication adherence: where do we go from here?

Abstract

185 ISSN 1758-1907 10.2217/DMT.13.9 © 2013 Future Medicine Ltd Diabetes Manage. (2013) 3(3), 185–188 For several decades, researchers have explored how patient–provider relationships can influence chronic illness care and outcomes. The domains of patient–provider communication – such as shared decision-making, trust and/or respect, and mutual understanding regarding treatment plans – are increasingly central to patient-centered models of care delivery. For example, new diabetes treatment guidelines call for individualizing clinical control targets, taking into consideration patient health status and risk factors, as well as psychological, social and economic conditions [1]. Actively engaging patients in setting treatment goals by assessing and incorporating their capacities, desires and values inherently requires effective patient–provider communication strategies. While much of the research on patient–provider communication among diabetes patients has focused on its influence on intermediate outcomes, such as control of cardiometabolic risk factors for complications (i.e., HbA1c, blood pressure and cholesterol), fewer studies have focused on the pathways between communication and diabetes self-management, such as medication adherence. Medication adherence among diabetes patients is theorized to be a proximal outcome of effective patient–provider communication, linked by such potential mechanisms as advancing patient understanding/knowledge, increasing the quality of medical decision-making and/or increasing patient self-efficacy or empowerment [2]. Improving medication adherence among diabetic patients is an important healthcare priority, given that nonadherence rates for medication regimens range from 10 to 40% depending on the study and pharmacological agent of interest [3]. In the longer term, poor adherence can lead to poorer clinical control and, in turn, higher rates of macroand micro-vascular complications. Moreover, poor adherence can jeopardize patient safety, when unsuspecting clinicians escalate dosages or intensify regimens, instead of addressing barriers to adherence. This editorial summarizes some of the most relevant literature on patient–provider communication and medication adherence among diabetes patients, raises important