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Sandra Petronio


Patient non-adherence to prescription medication protocols is a ubiquitous, dangerous problem, contributing to thousands of deaths, increased hospitalizations and unnecessary delay from recovery. The link between physician communication and patient adherence is strong, as patient perceptions of physician communication appear to influence subsequent adherence. Communication strategies that emphasize physician trust, intimacy, and support, and elevate patient involvement and control, have been shown to increase patient adherence. Further, collaboration and partnership between physicians and patients, and the use of contracts and written agreements have been shown to influence adherence. One hundred seven adult patients at a primary care medical facility located in a medium-sized, Midwestern city participated in this study. To qualify, each participant must have received a new prescription medication by the study physicians. In addition, pretest levels of adherence to medication protocols, and patient perceptions of physician communication competence were assessed. Participants were assigned to one of two treatment groups or to a control condition. Those in treatment group one entered into Partnership Agreements with their physician, formally establishing a collaborative partnership between physician and patient in order to improve patient health. Physician and patient responsibilities within the context of this relationship were articulated. Among the patients' responsibilities was adherence to the new prescription medication protocol. Those patients assigned to treatment two, entered into Medication Contracts with their physician. Medication Contracts expressed the patients' agreement to follow prescribed medication protocols however, they did not include any expression of partnership or collaboration between patient and physician. Those patients assigned to the control condition entered into no agreements or contracts with their physician. After a three-week interval, participant adherence to the prescribed medication protocol and patient perceptions of physician communication competence were assessed. Results indicate that those patients entering into Partnership Agreements with their physicians experienced a 20.6% increase in adherence to prescription medication protocols. Those participants entering into Medication Contracts experienced a 14.5% increase in prescription medication adherence. Those in the control condition experienced no significant change in their medication adherence. Additionally, it was found that neither Partnership Agreements nor Medication Contracts influence patient perceptions of physician communication competence.

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