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Those visitors here who also follow my other compliance-focused blog, AlignMap, will find little new in “Doctors Without Orders,” A Slate.com article about medication noncompliance by Jessica Wagner.

The material may seem, in fact, distinctly familiar to those readers since the article is largely based on an interview with me and data drawn from the AlignMap site.

I must admit that the material, however familiar it may be, looks pretty slick as written by Ms Wagner under the Slate aegis.

Jessica Wagner’s Slate.com essay on medication noncompliance can be found at ~ Doctors Without Orders ~

No Universal Solution For Patient Compliance

Source: Doctor knows best: take-charge patients have poorer outcomes

One of EnrichMap’s fundamental philosophical and pragmatic tenets has been that achieving optimal patient compliance requires customizing how clinicians, researchers, pharmacies, pharmaceutical manufacturers, and other heathcare providers interact with different patients. One size does not fit all.

This notion is hardly original with or unique to us. It is, in fact, in the mainstream beliefs of those working in the field of patient compliance.

At the same time, it is difficult to find, in the past 20 years, recommendations in the professional or lay press that veer far from “make the patient part of the treatment team.”

Consequently, it is, for those of us who regard the idea that a single approach to treatment is optimal for every patient suspect, heartening to see the report of a study published this week¹ that indicates that the current clinically and politically preferred mode, patient-centered treatment, which calls for the patient to be an active participant in treatment decisions and implementation, does not universally result in more successful outcomes.

The Study

The 12 month study followed 189 hypertensive patients who reported on their roles in treatment.

Researchers found that those patients who were more active in their approach had higher mean blood pressure (141 over 70) and cholesterol (LDL cholesterol of 122) than the more passive participants (average blood pressure: 137 over 72; average cholesterol: 92).

Other correlations were found, including the following:

Participants who preferred a patient-centered role characterized, were more likely to seek information about hypertension from outside sources.

Discussion

Austin Baldwin, a post-doctoral fellow in the Center for Research in the Implementation of Innovative Strategies in Practice at the VA Iowa City Health Care System, who was the primary investigator, comments on the findings in the press release:

Because the patients desirous of an active role in treatment had higher blood pressure and cholesterol scores but did not have significantly higher blood glucose scores than the other patients, Baldwin speculates that those patients invested in more intense participation in their own care had a harder time controlling asymptomatic conditions like high blood pressure.

Baldwin also notes that, in addition to a given patient’s degree of involvement in treatment decision-making, the level of agreement between the patient and his or her doctor about the patient’s role was significant. So, if the doctors were philosophically opposed to patients desiring more authority, that contention might result in impaired outcomes.

And, as we all (should) know, one study, especially one dealing with an abstract measure such as the self-reported level patient-centeredness desired, falls short of conclusive proof. Still Dr. Balwin’s conclusions appear justified:

The intuitive assumption is that the more involved people are with their health, the better they’ll be at managing chronic conditions. We found evidence to the contrary. Those who preferred a more ‘patient-centred’ or active role actually had higher blood pressure and lipid levels. Those who preferred a ‘provider-centred’ approach, in which the doctor is more authoritative, did better at managing their blood pressure and lipid levels.

The upshot of this research is that there isn’t a one-size-fits-all approach. It’s nice to think if we give everyone Treatment X, they’re all going to do well. But individual differences and preferences are important, and the value of studying this is to understand how these preferences can influence treatment adherence and ultimately influence people’s health.

Footnotes

1. Baldwin AS, et al. Preferences for a patient-centered role orientation: association with patient information seeking behavior and clinical markers of health. Annals of Behavioral Medicine 35(1), 2008.