February 6, 2013
Brief Intervention Improves Prescriber-Patient Communication About Medications

Los Angeles—It won’t come as much of a surprise to community pharmacists, but physicians aren’t sharing enough information with patients about the drugs they are prescribing.

That’s according to a new report in the Annals of Family Medicine, which discussed the success of a brief intervention in significantly improving communication.

UCLA researchers designed a program to teach physicians to provide five basic pieces of information to their patients: the medication's name, its purpose, the directions for its use, the duration of use, and the potential side effects. Prescribers showed significant improvement after completing the training, compared to a control group with no intervention, discussing at least one additional topic out of the five. In some cases, they even went farther and engaged patients in conversation about other pertinent facts involving the prescribed drug.

“We were pleasantly surprised to see that a simple intervention was effective in improving the content of discussions,” said Derjung Tarn, MD, PhD, the study's lead author and assistant professor of family medicine at UCLA’s David Geffen School of Medicine.

The clinical trial, conducted between February 2009 and February 2010, involved 27 primary care physicians and 256 patients. During a 1-hour interactive educational session, physicians were encouraged to communicate the five basic facts about prescribed medications. Meanwhile, participating patients also received a handout listing the five facts. Physician-patient interactions were then audiotaped, with the communication of the key facts to patients measured using the Medication Communication Index (MCI).

After training, the MCI for the physicians in the intervention group was 3.95 out of five, compared with 2.86 for the control group. Intervention-group doctors also received higher ratings from their patients on how they communicated information about medications—and other issues—than those in the control group.

“Interestingly, higher MCI scores also were associated with more reports of communication about topics not directly included in the intervention,” the researchers write. “For example, the intervention encouraged physicians to discuss potential medication side effects with patients, but patients also reported better communication about the risk of experiencing side effects and what to do if side effects occurred.”

“A physician-targeted educational session improved the content of and enhanced patient ratings of physician communication about new medication prescriptions,” study authors write. “Further work is required to assess whether improved communication stimulated by the intervention translates into better clinical outcomes.”

An Italian study, meanwhile, focused on a more specific use of an intervention to improve physician prescribing. Published recently by the journal Drugs and Aging, it described the results of a program to reduce prescribing of potentially inappropriate medications (PIMs) in older patients, using a combination of educational materials (i.e., a list of PIMs to always be avoided, along with a list of alternative drugs), training sessions, and annual reviews of PIM incidence data.

During the study period from the late 2007 to 2009, quarterly PIM exposure incidence rates among the older patients declined 31.4 % (7.8 % baseline to 5.3 % postintervention), compared with 21.6 % in a comparable group without intervention. Especially reduced were inappropriate prescribing for NSAIDs and digoxin.

“By reaching out to GPs and maintaining contact with them, this quality intervention appears to have positively impacted physicians’ awareness and prescribing behavior, which led to significant reductions in PIM exposures and likely translated to significant population health benefits among their older patients,” the Italian authors write. “Similar interventions tailored to target specific PIMs or focus on certain subpopulations of GPs may further improve prescribing quality among older people.”

U.S. Pharmacist Social Connect