Medication Adherence Improvement Similar for Shared Decision-Making Preference or Longer Patient-Provider Relationship.

Abstract

While increasing evidence supports the beneficial effects of shared decision making (SDM) on patient outcomes, the mechanisms underlying this relationship is unclear. This study evaluated length of the patient-provider relationship as one potential factor that may explain how SDM affects medication adherence in patients with hypertension. An observational study of 75 hypertensive patients and 27 providers in 3 primary care practices in New York City. A single-item measure assessed patients' preferences for decision-making style at baseline; medication adherence was collected over the 3-month study with an electronic monitoring device. Length of the relationship was measured as the number of years with the provider, and dichotomized as less than or greater than 1 year with the provider. Two generalized linear mixed models were conducted to determine whether the SDM-adherence association was modified by length of the relationship. Most patients were Black and women, and 64% were seeing the same provider >1 year. Providers were mostly White women and have been at the clinic for 6 years. In the main-effects model, patients were more likely to exhibit better adherence when they preferred shared and active decision-making styles as compared with those who preferred a passive style (<i>B</i> = 15.87 [Standard Error [SE]: 6.62], <i>P</i> = .02; and <i>B</i> = 22.58 [SE:7.62], <i>P</i> = .004, respectively). In Model 2, the relative importance of SDM on adherence decreased as years with the provider increased (t₍₄₈₎ = 2.13; <i>P</i> = .04). The benefits of SDM over passive decision making on medication adherence were reduced with increasing years of the patient-provider relationship. Having an established relationship with the provider may have a positive impact on medication adherence that is comparable to relationships high in SDM.