Maximizing Treatment Adherence: Physician–Patient Partnerships vs Procedures
In the August issue of Hypertension, Burnier et al1 open their review article with an encouragingly clear patient focus. They explicitly state effective hypertension management requires 2 types of patient behavior change: lifestyle modification and lifelong adherence to pharmacotherapy. The latter can work, they emphasize, “only if the patient is motivated to take the prescribed medication.” Yet, they fail to address further the critical role the physician should and must play in this process. In fact, the remainder of the article focuses entirely on poor drug adherence, without so much as mentioning lifestyle modification and patient motivation again.
Although the authors recognize the challenge of psychosocial hurdles, they completely ignore behavioral interventions, turning instead to a series of therapeutic solutions such as avoiding medication entirely, and advocating investigative procedures whose efficacy, as the authors themselves acknowledge, is currently unproven.
I believe this is not merely misguided, but represents precisely the wrong approach to recommend to physicians. It implies that patients are the problem because they cannot be trusted to take their medication and, as clinicians, we must find our own ways to compensate for their ineptitude. Such an attitude disempowers patients and further disincentivizes their active participation in self-management—something increasingly recognized as essential to managing chronic disease (including resistant hypertension), as noted by the authors themselves. The risk profile the authors describe, being black, poor, low in education, and high in depression, suggests that nonadherent hypertensive patients are already alienated. Physicians’ further disengagement from them in favor of technology will surely reinforce this sense of isolation and abandonment and only exacerbate their nonadherence.
White coat hypertension, referred to throughout the article, is perhaps the clearest evidence of the powerful influence physicians can have on their patients. Physicians and their patients might be better served by articles investigating communication and motivational techniques that enable physicians to translate this influence into positive, patient-oriented outcomes, rather than touting unproven proprietary products (to which at least one of the authors of this article has ties) and ignoring the relational and behavioral aspects of medical care entirely.
Benjamin A. Bensadon
Department of Integrated Medical Sciences
Charles E. Schmidt College of Medicine
Florida Atlantic University
Boca Raton, FL
- © 2013 American Heart Association, Inc.