Patient and physician beliefs about control over health: association of symmetrical beliefs with medication regimen adherence

Abstract

Background: Past work suggests that the degree of similarity between patient and physician attitudes may be an important predictor of patient-centered outcomes.

Objective: To examine the extent to which patient and provider symmetry in health locus of control (HLOC) beliefs was associated with objectively derived medication refill adherence in patients with co-morbid diabetes mellitus (DM) and hypertension (HTN).

Participants: Eighteen primary care physicians at the VA Iowa City Medical Center and affiliated clinics; 246 patients of consented providers with co-morbid DM and HTN.

Design: Established patient-physician dyads were classified into three groups according to the similarity of their HLOC scores (assessed in parallel). Data analysis utilized hierarchical linear modeling (HLM) to account for clustering of patients within physicians.

Main measures: Objectively derived medication refill adherence was computed using data from the VA electronic pharmacy record; blood pressure and HgA1c values were considered as secondary outcomes.

Key results: Physician-patient dyads holding highly similar beliefs regarding the degree of personal control that individual patients have over health outcomes showed significantly higher overall and cardiovascular medication regimen adherence (p = 0.03) and lower diastolic blood pressure (p = 0.02) than in dyads in which the patient held a stronger belief in their own personal control than did their treating physician. Dyads in which patients held a weaker belief in their own personal control than did their treating physician did not differ significantly from symmetrical dyads. The same pattern was observed after adjustment for age, physician sex, and physician years of practice.

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 to physicians with similar attitudes towards care.