Primary Care

Patients more likely to follow medication regimens if they share their doctor's beliefs about causes of health outcomes

When the patient and provider have similar attitudes about the causes of health outcomes, patients are more likely to adhere to their medication regimens, concludes a new study. One method used to assess these attitudes is the health locus of control (HLOC) beliefs six-item scale. The critical element measured by HLOC is the degree to which a patient attributes health outcomes to factors under her own control or to external factors such as chance or actions of the provider. A parallel version of the HLOC constructed by the study researchers also measures the provider's related beliefs.

The researchers measured the extent to which patient and provider symmetry in HLOC beliefs was associated with medication refills in 244 male veterans with coexisting diabetes and hypertension. The veterans were being treated by 27 primary care physicians at the Veterans Administration Iowa City Medical Center and clinics. Medication adherence was measured by an electronic pharmacy record. In physician-patient dyads holding highly similar beliefs regarding the degree of personal control that individual patients have over health outcomes, both overall and cardiovascular medication regimen adherence was significantly higher than in dyads in which the patient held a stronger belief in their own personal control than their treating physician's beliefs regarding patients in general.

The symmetrical group also had lower diastolic blood pressure than the nonsymmetrical group. When compared with the symmetrical group, the nonsymmetrical group had a 50 percent higher rate of medication nonadherence. Based on their findings, the researchers suggest examining the feasibility of matching patients and providers based upon their similarity on the HLOC attitudinal measure. The study was supported in part by the Agency for Healthcare Research and Quality (HS16094).

See "Patient and physician beliefs about control over health: Association of symmetrical beliefs with medication regimen adherence," by Dr. Christensen, M. Bryant Howren, Ph.D., Stephen L. Hillis, Ph.D. and others in the Journal of General Internal Medicine 25(5), pp. 397-402, 2010.

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