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Randomized Controlled Trial
, 26 (4), 409-20

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

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Randomized Controlled Trial

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

Jessica E Kaplan et al. J Am Board Fam Med.

Abstract

Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.

Methods: We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.

Results: Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: rs ≥0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: rs ≥0.25; P < .05). In an adjusted analysis, empathy (t = 2.3; P = .027) and ≥2 CT statements (t = 2.3; P = .024) were associated with higher PDC.

Conclusions: Clinician empathy, reflections, and MIAs may elicit patient CT, whereas empathy and CT seem to enhance filling an initial prescription and PDC.

Keywords: Antidepressive Agents; Communication; Depression; Patient Adherence; Quantitative Evaluation.

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