Download Appendix A

Appendix A. Articles included in meta-analysis of correlational studies (n=106) and details of studies used in meta-analysis.
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Apter AJ, Reisine ST, Affleck G, et al. Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and healthbelief differences. Am J Respir Crit Care Med. 1998;157:1810-1817.
Arnsten JH, Gelfand JM, Singer DE. Determinants of compliance with anticoagulation: A case-control study. Am J Med.
1997;103:11-17.
Bakken S, Holzemer WL, Brown MA, et al. Relationships between perception of engagement with health care provider
and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS
Patient Care STDS. 2000;14:189-197.
Bartlett EE, Grayson M, Barker R, et al. The effects of physician communications skills on patient satisfaction; recall, and
adherence. J Chronic Dis. 1984;37:755-764.
Beach MC, Sugarman J, Johnson RL, et al. Do patients treated with dignity report higher satisfaction, adherence, and
receipt of preventive care? Ann Fam Med. 2005;3:331-338.
Beach MC, Duggan PS, Moore RD. Is patients' preferred involvement in health decisions related to outcomes for patients
with HIV? J Gen Intern Med 2007;22:1119-1124
Bula CJ, Alessi CA, Aronow HU, et al. Community physicians' cooperation with a program of in-home comprehensive
geriatric assessment. J Am Geriatr Soc. 1995;43:1016-1020.
Burgoon JK, Pfau M, Pattoyy R, et al. Relational communication, satisfaction, compliance-gaining strategies, and
compliance in communication between physicians and patients. Commun Monogr. 1987;54:307-324.
Campbell TA, Auerbach SM, Kiesler DJ. Relationship of interpersonal behaviors and health-related control appraisals to
patient satisfaction and compliance in a university health center. J Am Coll Health 2007;55:333-340
Catz SL, Heckman TG, Kochman A, et al. Rates and correlates of HIV treatment adherence among late middle-aged and
older adults living with HIV disease. Psychol, Health Med. 2001;6:47-58.
Cecil DW, Killeen I. Control, compliance, and satisfaction in the family practice encounter. Fam Med. 1997;29:653-657.
Cho AH, Voils CI, Yancy WS, Jr., et al. Does participatory decision making improve hypertension self-care behaviors and
outcomes? J Clin Hypertens (Greenwich) 2007;9:330-336
Christen RN, Alder J, Bitzer J. Gender differences in physicians' communicative skills and their influence on patient
satisfaction in gynaecological outpatient consultations. Soc Sci Med 2008;66:1474-1483
Cockburn J, Gibberd RW, Reid AL, et al. Determinants of non-compliance with short term antibiotic regimens. Br Med J
(Clin Res Ed). 1987;295:814-818.
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Cvengros JA, Christensen AJ, Hillis SL, et al. Patient and physician attitudes in the health care context: attitudinal
symmetry predicts patient satisfaction and adherence. Ann Behav Med 2007;33:262-268
Davis MS. Variations in patients' compliance with doctors' advice: an empirical analysis of patterns o communication. Am
J Public Health Nations Health. 1968;58:274-288.
DiMatteo MR, Hays RD, Prince LM. Relationship of physicians' nonverbal communication skill to patient satisfaction,
appointment noncompliance, and physician workload. Health Psychol. 1986;5:581-594.
DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians' characteristics influence patients' adherence to medical
treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12:93-102.
Falvo D, Tippy P. Communicating information to patients. Patient satisfaction and adherence as associated with resident
skill. J Fam Pract.1988;26:643-647.
Fassaert T, van Dulmen S, Schellevis F, et al. Raising positive expectations helps patients with minor ailments: a crosssectional study. BMC Fam Pract 2008;9:38
Federman AD, Cook EF, Phillips RS, et al. Intention to discontinue care among primary care patients: influence of
physician behavior and process of care. J Gen Intern Med 2001;16:668-674
Francis V, Korsch BM, Morris MJ. Gaps in doctor-patient communication. Patients' response to medical advice. N Engl J
Med. 1969;280:535-540.
Frank JC, Hirsch SH, Chernoff J, et al. Determinants of patient adherence to consultative comprehensive geriatric
assessment recommendations. J Gerontol A Biol Sci Med Sci. 1997;52:M44-51.
Freemon B, Negrete VF, Davis M, et al. Gaps in doctor-patient communication: doctor- patient interaction analysis.
Pediat Res 1971:298-311.
Friedman DS, Hahn SR, Gelb L, et al. Doctor-patient communication, health-related beliefs, and adherence in glaucoma
results from the Glaucoma Adherence and Persistency Study. Ophthalmology 2008;115:1320-1327, 1327 e1321-1323
Gauchet A, Tarquinio C, Fischer G. Psychosocial predictors of medication adherence among persons living with HIV. Int J
Behav Med 2007;14:141-150
Graber AL, Wooldridge K, Brown A. Effects of intensified practitioner-patient communication on control of diabetes
mellitus. South Med J. 1986;79:1205-1209.
Grant CH, 3rd, Cissna KN, Rosenfeld LB. Patients' perceptions of physicians communication and outcomes of the accrual
to trial process. Health Commun. 2000;12:23-39.
Gunter-Hunt G, Ferguson KJ, Bole GG. Appointment-keeping behavior and patient satisfaction: implications for health
professionals. Patient Couns Health Educ. 1982;3:156-160.
Hall JA, Roter DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav. 1981;22:18-30.
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Hanson CL, Henggeler SW, Harris MA, et al. Associations between family members' perceptions of the health care system
and the health of youths with insulin-dependent diabetes mellitus. J Pediatr Psychol. 1988;13:543-554.
Harris LE, Luft FC, Rudy DW, et al. Correlates of health care satisfaction in inner-city patients with hypertension and
chronic renal insufficiency. Soc Sci Med. 1995;41:1639-1645.
Haskard KB, Williams SL, DiMatteo MR, et al. The provider’s voice: patient satisfaction and the content-filtered speech
of nurses and physicians in primary medical care. J Nonverb Behav. 2008; 32:1-20.
Hauck FR, Zyzanski SJ, Alemagno SA, et al. Patient perceptions of humanism in physicians: effects on positive health
behaviors. Fam Med. 1990;22:447-452.
Hazzard A, Hutchinson SJ, Krawiecki N. Factors related to adherence to medication regimens in pediatric seizure patients.
J Pediatr Psychol. 1990;15:543-555.
Heiby EM, Gafarian CT, McCann SC. Situational and behavioral correlates of compliance to a diabetic regimen. J Compl
Health Care. 1989;4:101-116
Heisler M, Bouknight RR, Hayward RA, et al. The relative importance of physician communication, participatory decision
making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243-252.
Heisler M, Cole I, Weir D, et al. Does physician communication influence older patients' diabetes self-management and
glycemic control? Results from the Health and Retirement Study (HRS). J Gerontol A Biol Sci Med Sci 2007;62:1435-1442
Hershey JC, Morton BG, Davis JB, et al. Patient compliance with antihypertensive medication. Am J Public Health.
1980;70:1081-1089.
Heszen-Klemens I, Lapinska E. Doctor-patient interaction, patients' health behavior and effects of treatment. Soc Sci Med.
1984;19:9-18.
Hirsh AT, Atchison JW, Berger JJ, et al. Patient satisfaction with treatment for chronic pain: predictors and relationship to
compliance. Clin J Pain. 2005;21:302-310.
Honda K, Kagawa-Singer M. Cognitive mediators linking social support networks to colorectal cancer screening
adherence. J Behav Med 2006;29:449-460.
Hovinga CA, Asato MR, Manjunath R, et al. Association of non-adherence to antiepileptic drugs and seizures, quality of
life, and productivity: survey of patients with epilepsy and physicians. Epilepsy Behav 2008;13:316-322.
Hulka BS, Kupper LL, Cassel JC, et al. Doctor-patient communication and outcomes among diabetic patients. J
Community Health. 1975;1:15-27.
Hulka BS, Cassel JC, Kupper LL, et al. Communication, compliance, and concordance between physicians and patients
with prescribed medications. Am J Public Health. 1976;66:847-853.
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Ingersoll KS, Heckman CJ. Patient-clinician relationships and treatment system effects on HIV medication adherence.
AIDS Behav. 2005;9:89-101.
Inui TS, Carter WB, Kukull WA, et al. Outcome-based doctor-patient interaction anaylsis: I. Comparison of techniques.
Med Care. 1982;20:535-549.
Jahng KH, Martin LR, Golin CE, et al. Preferences for medical collaboration: patient-physician congruence and patient
outcomes. Patient Educ Couns. 2005;57:308-314.
Jones FA, Caldwell HS. Factors affecting patient compliance with diagnostic recommendations. Am J Orthopsychiatry.
1981;51:700-709.
Kahn KL, Schneider EC, Malin JL, et al. Patient centered experiences in breast cancer: predicting long-term adherence to
tamoxifen use. Med Care 2007;45:431-439
Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health
literacy. J Gen Intern Med. 1999;14:267-273.
Kerse N, Buetow S, Mainous AG, 3rd, et al. Physician-patient relationship and medication compliance: a primary care
investigation. Ann Fam Med. 2004;2:455-461.
Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health
Prof. 2004;27:237-251.
Kravitz RL, Hays RD, Sherbourne CD, et al. Recall of recommendations and adherence to advice among patients with
chronic medical conditions. Arch Intern Med. 1993;153:1869-1878.
Kressin NR, Wang F, Long J, et al. Hypertensive patients' race, health beliefs, process of care, and medication adherence. J
Gen Intern Med 2007;22:768-774
Krupat E, Stein T, Selby JV, et al. Choice of a primary care physician and its relationship to adherence among patients with
diabetes. Am J Manag Care. 2002;8:777-784.
Kyngas H, Hentinen M, Barlow JH. Adolescents' perceptions of physicians, nurses, parents and friends: help or hindrance
in compliance with diabetes self-care? J Adv Nurs. 1998;27:760-769.
Kyngas H. Compliance with health regimens of adolescents with epilepsy. Seizure. 2000;9:598-604.
Kyngas HA. Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus). Chronic Illn
2007;3:20-28
Lassen LC. Connections between the quality of consultations and patient compliance in general practice. Fam Pract.
1991;8:154-160.
Lerman I, Lozano L, Villa AR, et al. Psychosocial factors associated with poor diabetes self-care management in a
specialized center in Mexico City. Biomed Pharmacother. 2004;58:566-570.
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Ley P, Whitworth MA, Skilbeck CE, et al. Improving doctor-patient communication in general practice. J R Coll Gen
Pract.1976;26:720-724.
Linn LS, Wilson RM. Factors related to a communication style among medical house staff. Med Care. 1980;18:1013-1019.
Linn MW, Linn BS, Stein SR. Satisfaction with ambulatory care and compliance in older patients. Med Care. 1982;20:606614.
Litt IF, Cuskey WR. Satisfaction with health care. A predictor of adolescents' appointment keeping. J Adolesc Health
Care. 1984;5:196-200.
Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with
asthma. Med Care. 1988;26:1119-1128.
Matsui D, Joubert GI, Dykxhoorn S, et al. Compliance with prescription filling in the pediatric emergency department.
Arch Pediatr Adolesc Med. 2000;154:195-198.
McGinnis B, Olson KL, Magid D, et al. Factors related to adherence to statin therapy. Ann Pharmacother 2007;41:18051811.
McKee MD, Lurio J, Marantz P, et al. Barriers to follow-up of abnormal Papanicolaou smears in an urban community
health center. Arch Fam Med 1999;8:129-134
Mishra P, Hansen EH, Sabroe S, et al. Adherence is associated with the quality of professional-patient interaction in
Directly Observed Treatment Short-course, DOTS. Patient Educ Couns. 2006;63:29-37.
Molassiotis A, Morris K, Trueman I. The importance of the patient-clinician relationship in adherence to antiretroviral
medication. Int J Nurs Pract 2007;13:370-376
Nagy VT, Wolfe GR. Cognitive predictors of compliance in chronic disease patients. Med Care. 1984;22:912-921.
Naik AD, Kallen MA, Walder A, et al. Improving hypertension control in diabetes mellitus: the effects of collaborative and
proactive health communication. Circulation 2008;117:1361-1368
Nathanson CA, Becker MH. The influence of client-provider relationships on teenage women's subsequent use of
contraception. Am J Public Health. 1985;75:33-38.
O'Malley AS, Sheppard VB, Schwartz M, et al. The role of trust in use of preventive services among low-income AfricanAmerican women. Prev Med. 2004;38:777-785.
Pearce T, O'Shea JS, Wessen AF. Correlations between appointment keeping and reorganization of hospital ambulatory
pediatric services. Pediatrics. 1979;64:81-87.
Piette JD, Schillinger D, Potter MB, et al. Dimensions of patient-provider communication and diabetes self-care in an
ethnically diverse population. J Gen Intern Med. 2003;18:624-633.
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Piette JD, Heisler M, Krein S, et al. The role of patient-physician trust in moderating medication nonadherence due to cost
pressures. Arch Intern Med. 2005;165:1749-1755.
Podell RN, Kent D, Keller K. Patient psychological defenses and physician response in the long-term treatment of
hypertension. J Fam Pract. 1976;3:145-149.
Politi MC, Clark MA, Rogers ML, et al. Patient-provider communication and cancer screening among unmarried women.
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Reed BD, Lutz LJ, Zazove P, et al. Compliance with acute otitis media treatment. J Fam Pract. 1984;19:627-632.
Remien RH, Bastos FI, Jnr VT, et al. Adherence to antiretroviral therapy in a context of universal access, in Rio de Janeiro,
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Rost K, Carter W, Inui T. Introduction of information during the initial medical visit: consequences for patient followthrough with physician recommendations for medication. Soc Sci Med. 1989;28:315-321.
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First
Author,
Year
Type of
Doctor,
Setting
of Studya
Disease
Communication Measure:
How assessed; Description
of Measure c
PU
Specialty
of MD,
Number
of
Doctorsb
S, 0
Apter,
1998
Asthma
Arnsten,
1997
PU
S, 0
Bakken,
2000
PS
P S, 0
Long-term
anticoagulation
therapy for
ischemic
stroke
HIV
Bartlett,
1984
RU
P, 5
V: rating by patient; provider Electronic device
communication about
measured
asthma
actuations of
corticosteroid
inhaler device
B: rated by patient; Phone
Continued therapy
interview regarding feelings versus dismissed
of satisfaction or
from clinic for
dissatisfaction with regular
nonadherence to
physician
anti-coagulation
medication
V: rating by patient;
Patient selfengagement with the health
report: adherence
care provider
to medication,
appointments,
provider advice;
Morisky scale
V: coded on videotapes;
Patient self-report
interchange of information
(phone interview)
and interpersonal skills
of post-visit re:
patient adherence
to regimen
Various
conditions
in primary
care
Adherence
Measure
Time Period
to Assess
Adherence d
Study n
(a=
adults,
p=peds)
r
42 days
50a
.44
Past
adherenceretrospective
132a
.16
0
707a
.11
1-2 wks
60a
.19
Beach,
2005
PS
ALL, 0
Beach,
2007
UP
P, 0
HIV
B: patient rated;
quality of communication,
known as a person;
Involvement in decisions;
provider explanations
understandable
Bula,
1995
PC
P, 50
Primary
care
B: rating; nurse assessment
of doctor accessibility,
interest and cooperation
Burgoon,
1987
PS
P, 0
Primary
care
B: rated; compliance gaining
strategies; Telephone
interviews with patients
about their physicians'
communication skills
----
B; rating by patient;
involvement in decisionmaking and being treated
with respect
Patient self-report
of adherence to
doctor's
advice/treatment
plan
Patient selfreport: validated
survey, pt. reports
how many doses
they have missed
using a 24-hour,
3-day,
and 2-week recall
Patient adherence
to Comprehensive
Geriatric
Assessment
recommendations
Patient self-report
in interview:
adherence to
physician
recommendations
0
4156a
.05
0
687a
.01
Up to 3 years
81a
.23
0
224a
.15
Campbell,
2007
PNU
P, 14
Generalvarious
Catz, 2001 PC
P, 0
HIV
Cecil,
1997
RU
F, 15
Family
practice
Christen,
2008
URP
S, 49
GYN
outpatient
care
B: rated; match of
Participatory Style of
Physician Scale (PSPS) rated
by patient and physician
after visit
Patient Selfreport; singleitem face valid
measure; subjects
asked how well
they rated their
overall level of
compliance on a
5-point Likert
scale
B: rated by patient;
Patient self-report
satisfaction with providermedication
patient relationship
adherence
V: coded; verbal control
Patient self-report
behaviors relational
of adherence to
communication; Ratings of
regimen proposed
physician communication
by family
from videotapes
physician
B: independent rated videos; Real (30) and
Revised Maastricht History- simulated (166)
Taking and Advice
patients rated
Checklist; Analyzed 196
their Self-reported
videotapes of 30 real-life and Expected
166 simulated (standardized) Compliance
patient
2 wks
80a
.08
0
84a
.28
2-3 wks
50a
.35
0
196a
.14
Cho, 2007
VPN
P, 30
High Blood
Pressure
Cockburn,
1987
PC
F, 108
Antibiotic
regimen for
infections
Cvengros,
2007
UP
P, 16
general
primary
care
B: ratings by Patient;
providers’ Participatory
Decision Making style
assessed using a validated 3item Kaplan and Greenfield
scale
Adherence to
0
554a
antihypertensive
medication
regimens:
4-item self-report
instrument,
Morisky Scale
V: coding of doctor verbal
Pill counts and
7-10 days
233a
behavior; doctor provision of home interview of
specific advice to patient on patient report of
complexity and duration of
number of tablets
treatment
taken versus
number
prescribed
V: Convergence of stated
SR -MOS General 2 wks – 6 mos 146a
attitudes held by patients and Adherence Scale
their physicians about the
patient role;
Dr and patient filled out
Multidimensional Health
Locus of
Control questionnaire and
the Patient-Practitioner
Orientation
Scale (PPOS))
. 01
.14
.12
Davis,
1968
MU
P, 76
General
medical
clinic
V: coded; Bales IPA;
Physician communication
skills coded from tape
recordings of physicianpatient interactions
DiMatteo,
1986
RU
F, 28
Family
practice
clinic
DiMatteo,
1993
PC
FPS, 186
Fassaert,
2008
CP
F, 195
Diabetes,
high blood
pressure,
heart
disease
generalminor
B: rated; communication
accuracy; Videotape
assessment of nonverbal
encoding and decoding, selfreport measures of empathy
and communication
V: coded patient report;
Doctor set up future
appointment and answered
all questions
B: coded videotaped
consultations; active
listening and positive
communication with the
validated Active Listening
Observation Scale (ALOSglobal), providing
reassurance, a clear
explanation, prognosis;
Patient self-report 4 measures;
of adherence to
variable times
physicians' advice
/recommendations
to meds, diet, rest
habits, worry,
smoking, alcohol,
work activities
Appointment
6 months
adherence
111a
.16
28a
.28
Patient self-report
of medicationtaking, exercise,
and diet
2 yrs
186a
.12
Self-reported
Morisky
medication
adherence
(MAQ).
2 wks
524a
.02
Falvo,
1988
RU
F, 11
Family
practice
residency
V: coded behavior from
videotape and rated PDIS
patient-doctor interaction
scale
Observation of
patient
appointmentkeeping
f/u no time
specified
29a
.34
Federman,
2001
UHPS
P, 11
General
Primary
Care
B: rating by patients; rated
physician listening,
involvement, answers
questions, addresses reason
for visit, etc
0
2728a
.06
Francis,
1969
RU
C, 0
Children's
hospital
clinic
(various
diagnoses)
B: rated; maternal
perceptions; Assessment of
physician communication
and friendliness in
audiotapes of interactions
7-14 days
587p
.10
Frank,
1997
PC
P, 97
B: rating by patient;
communication with
physician about specific
recommendations and doctor
global communication
3 mos
139a
.15
Freemon,
1971
RFU
C, 0
Elder
patients
receiving
Comprehensive
Geriatric
Assessment
Pediatric
walk-in
clinic
Self-reported
patient
willingness to
return to the
clinic/intent to
adhere
Mother’s
perception of
physician
friendliness and
understanding of
their concerns
Patient adherence
to Comprehensive
Geriatric
assessment
recommendations
(reported in
interview)
Mother-report of
following doctor's
instructions about
medical regimen
and prescriptions
7- 14 days
169p
.21
V: coded; Bales IPA;
Assessment of physician
positive affect
Friedman,
2008
CP
S, 103
Glaucoma
V: rating by patient;
communication and
information about glaucoma
Tx from doctor
Gauchet,
2007
UP
P, 0
HIV
B: patient rating; confidence
in their physician
Graber,
1986
PNC
S, 1
Diabetes
Grant,
2000
PFU
S, 0
Cancer
B: coding of behavior;
Feedback and
communication about
glucose monitoring between
patient and health
professional
N: rated; 20 item 6 pt scale
measure of affiliation and
dominance
GunterHunt,
1982
PRNU
S, 23
Arthritis
B: rated by patient;
communication and
friendliness
Self-report
adherence to
medications in
structured
interview; and
pharmacy data
medication
possession ratios
Pt. self-report
adherence to
medication scale,
devised for this
study
Glycosylated
hemoglobin
3-12 mos
previous
300a
.17
0
127a
.24
1 year
233a
.20
Patient agreement
to participate in
cancer clinical
trial
0
126a
.15
0
150a
.00
Patient self-report
and Medical
records:
Appointment
adherence
Hall, 1981
PU
F, 2
General
medicine
B: rating of audio and voice
tone; analysis of physicians’
affective behavior and
patient contentment with the
visit
B: rating by adolescent
patient; personal and
professional aspects of
doctor
Hanson,
1988
PC
C, 0
Diabetes
Type I
Harris,
1995
PRU
F, 0
Hypertensio
n
Haskard,
2008
UCPR
P, 51
General
N: Raters’ judgments;
primary care content-filtered voice tone
(warm, competent,
enthusiastic, and not hostile)
Hauck,
1990
RUPC
F, 26
General
N: rated; Humanism scale;
care/
Ratings by patients of
primary care residents' and primary care
physicians’ instrumental and
socio-emotional
communication
B: rating scale; Home
interview: PSQ-RAND
Patient
appointmentkeeping records
4 mos
50a
.16
Patient self-report
and observational
methods scale:
use and adherence
to diet, insulin,
glucose,
hypoglycemia,
and foot care
Patient selfreport/ home
interview about
medication
completion
Patients’ selfreported
adherence to
medication
recommendations
Self-report of
patients given
health advice, that
they tried to
adhere to the
following: diet,
exercise, and quit
smoking.
0
96p
.15
0
333a
.13
0
199a
.29
0
23a
.10
Hazzard,
1990
PU
C, 0
Pediatric
seizure
B: rated by parent and child;
satisfaction with medical
care and that doctors takes
care of patient
Heiby,
1989
PS
PS, 0
N: rating by patient;
physician has a friendly
manner
Heisler,
2002
PS V
I, 0
Diabetes
Type I
(n=81) and
Type II
(n=55)
Diabetes
Heisler,
2007
PCS
P, 0
Diabetes
B: rated by patient;
physician provision of info
(PCOM) and participation in
decision making (PDM)
Hershey,
1980
PNU
S, 0
High blood
pressure
B: rated by patient;
satisfaction with providers
and support by providers
V: rating by patient of doctor
explanations and providerpatient decision-making
style
Medication, blood 3 mos
levels, and
concentration of
seizure
medication
Patient self-report 0
of adherence to
many aspects of
diabetes care
35p
.38
144a,p
.22
Patient self-report
of their '
management of
diabetes care
(meds, diet,
exercise, etc.)
Self-report
adherence to
diabetes
management
0
1314a
.08
0
1588a
.08
Patient self-report
of medication
taking
(dichotomous
measure); patient
estimate of pills
missed and how
many taken
0
132a
.08
HeszenKlemens,
1984
PFU
S, 11
TB, CHD,
catarrhalis
gingivitis
Hirsh,
2005
PU
S, 3
Chronic
pain
Honda,
2006
PCS
P, 0
Colorectal
cancer
screening
Hovinga,
2008
CP
S, 175
Epilepsy
Hulka,
1975
PC
S, 42
Diabetes
V: coded; verbal response
codes similar to Bales and
Stiles
Patient self-report
in interview re:
following doctors'
instructions
B: rating by patients;
Patient self-report
Satisfaction with care on
of participant
PSRS
compliance (selfreport scale
PCRS) and health
professional
compliance
evaluation
B: rating; provider-patient
SR of three
communication: information, colorectal cancer
communication, respect;
screening tests
shared decisions
B: patient rated; comfortable Self reported
discussing missed doses with adherence to
doctor; and trust doctor to
antiepileptic
make best decision for them medicationsurvey
V: coded verbal behavior;
Diabetes control
Patient report of
including testing
communication of
blood sugar,
information about diabetes
weight
and care
maintenance,
hypoglycemic
episodes; Patient
self-report
2wks to 6 mos 62a
.21
0
180a
.22
0
341a
.12
0
408a
.08
2 wks
213a
-.02
Hulka,
1976
PC
F, 46
Diabetes,
Congestive
heart failure
V: coding of doctor and
patient communication;
instructions and information
regarding medication
Ingersoll,
2005
PU
S, 0
HIV
B: rated by patient; Primary
Care Assessment Survey
(clinical interaction and
interpersonal treatment and
trust)
Inui, 1982
PRV
I, 13
General
medical
clinic
V: coded; Bales IPA on
verbal communication and
styles
Jahng,
2005
PRCU
P, 50
Diabetes
V: rating by patient,
congruence regarding
involvement in care/
decision-making
Pharmacy records
of medication
adherence; chart
information; and
patient interview
(Patient selfreport) about
medication
adherence
Patient self-report
on Medication
Adherence form,
and doctor’s
electronic medical
record notation of
compliance
Patient
compliance with
medications over
three months
based on
pharmacy records
Patient self-report
of adherence to
treatment
recommendations.
RAND General
Adherence Scale.
2 wks
357a
.05
s-r = 0;
electronic =
past week
120a
.15
3 mos
55a
.57
0
211a
.17
Jones,
1981
RU
C, 0
Variety of
medical
problems
V: rated; Parent-report that
treatment regimen was
conveyed in clear and
precise manner
Kalichma
n, 1999
POC
PS, 0
HIV
B: rated by patient;
Perceived quality of
relationship
Kerse,
2004
PC
P, 22
General
practice
B: rated by patient,
concordance, trust, integrity
Kahn,
2007
CS
S, 0
Breast
cancer
Kim, 2004 PU
I, 0
Kravitz,
1993
PFS, 349
Various
chronic
illnesses
Diabetes,
High blood
pressure,
Heart
disease
V: patient rated; verbal
communication and decision
making; being told about
side effects in advance;
received support from hp's
B: rating by patient; patient
satisfaction scale
PC
V: rating by patient;
Physician communication of
instructions so patients
recalled them
Parent self-report 0
of compliance
with
recommendations
of physician
Patient self-report
of combined
antiretroviral
medication
adherence
Patient self4 days
report: medication
adherence
Self reported
4 years
persistence
(continued use of
tamoxifen use )
Patient self-report 0
on General
Adherence Scale
Patient self-report 0
of adherence to
recalled
recommendations;
MOS general
adherence scale
and specific
diabetes
adherence
0
156p
.37
184a
.11
172a
.13
881a
.10
550a
.57
1751a
.04
Kressin,
2007
PV
P, 0
High blood
pressure
V: Patient coded; Behavior
on Ockene measure-whether doctor and patient
discussed how to take
medication
Krupat,
2002
PCH
P, 40
Diabetes
B: coding; Patient with
physician they chose versus
physician who was assigned
to them
Kyngas,
1998
PNOC
C, 0
Diabetes
V: rating by patient; doctor’s
communication
Kyngas,
2000
PNS
ALL, 0
N: rated by patient; support
from the physician
Kyngas,
2007
UP
S, 0
Epilepsy
among
adolescents
Diabetes
N: patient rated; support
from their physician;
Patient self-report
of medication
adherence using
Morisky scale and
specific questions
about pill use
Patient self-report
of and HMO
records of patient
adherence to
recommended
tests for
prevention
Patient self-report
Scale of
compliance with
diabetes self-care
(insulin, diet,
glucose
monitoring)
Patient self-report
of adherence to
health regimens
patient self
reported
adherence to
diabetes regimen
0
793a
.09
12 mos
463a
.10
0
48p
.43
0
232p
.50
0
289 p
.18
Lassen,
1991
PC
F, 1
Family
practice
Lerman,
2004
PC
I, 0
Diabetes
Ley, 1976
PC
F, 1
General
practice
Linn,
1980
RU
I, 71
Internal
medicine
Linn,
1982
PRV
P, 0
Ambulatory care
clinic
Litt, 1984
PU
C, 0
General
adolescent
clinic
V: coded interaction from
tape recording;
communication achieved (or
not) based on 6
communication criteria
Patient self-report
(questionnaire
sent to patients)
compliance with
advice on
medications or
lifestyle
B: rating by patient;
Patient self-report
evaluation of communication of Self-care
with physician
management on
the Self-Care
Inventory
V: rating by patient;
Patient self-report
satisfaction with
of medication
communication of
adherence on
information
postal
questionnaire
V: ratings; value of doctor
Appointment
on Facilitating Response
compliance
Index
B: rated by patient;
Patient self-report
Satisfaction with Physician
and pill count of
and Primary Care (45-item
adherence to
scale)
many regimens
V: rating by adolescent of
Appointmentcare; Adolescent Satisfaction keeping
Questionnaire (21-item
questionnaire)
3 weeks
63a
.36
0
176a
.15
0
157a,p
.23
6 mos
58a
.30
2 mos
866a
.22
1 month
63p
.27
Manson,
1988
PRU
FI, 30
Asthma
V: coded; doctor-patient
language concordance
Patient
medication levels;
office
appointment
records
8 years
96a
.09
Matsui,
2000
PC
C, 0
Pediatrics/E
mergency
Department
V: rating by patient;
Satisfaction vs.
dissatisfaction with
explanation of the medical
problem; instructions for
treatment and follow-up
Patient self-report
of telephone
interview about
filling
prescription
5 days
1014p
.09
McGinnis,
2007
CS
P, 0
dyslipidemi
a
255a
.15
PC
F, 0
Cervical
Cancer
screening
Adherence to
statin therapy
determined by
pharmacy claims
data (patients
continued versus
discontinued)
Patient selfreport: Return or
failure to return
for colposcopy
after abnormal
PAP
0
McKee,
1999
B: rated by patient;
telephone survey re:
communication with health
care providers; trust in
doctor; and doctor has
adequate knowledge to
answer pt. questions
V: patient coded;
understood info from doctor
and easy to get doctor to
understand my needs
0
202a
.18
Mishra,
2006
PC
P, 0
General
practice
V: rated by patient;
assessments of
communication by
physicians
Directly Observed 0
Tuberculosis
medication
adherence
135a
.21
Molassioti
s, 2007
PNC
S, 0
HIV
B: patient rated; Patient–
Provider Relationship scale.
-- 15-item scale measuring
the quality of the
relationship
between the patient and the
health-care provider;
perception of being valued
and
respected by clinician, the
patients’ ability to initiate
discussions about treatment,
empowerment and level of
trust
Nagy,
1984
PRV
P, 0
Diabetes,
high blood
pressure,
respiratory
diseases
B: rating by patient; 4 scales
about satisfaction with VA
clinic treatment
Naik,
2008
PV
P, 0
High blood
pressure
V: rated by patient on
questionnaire ; proactive
communication with
clinician and clinician's use
of collaboration
Adherence selfreport,
past 4 days
calculating
percentage of
missed doses and
Simplified
Medication
Adherence Scale
(SMAQ) six-item
scale whether
patients take
medication and
how often they
missed dose; and
pill count
Medication
adherence (selfreport, provider
report, on time
refills) and selfmanagement
(self-report and
provider report)
Pharmacy records
of hypertension
medication refills
0
38a
.34
6 mos
128a
.28
Past 7 days
212a
.16
Nathanson N
, 1985
HEALT
H DEPT
CLINIC
--
Contracepti
ve use
B: rated by patient; post-visit
report of communication and
trust in health care provider;
evaluation of being given
enough information and time
Preventive
B: rating by patient;
servicessatisfaction and trust in
primary care primary care physician
O’Malley,
2004
PS
P, 0
Pearce,
1979
MRU
C, 0
Ambulatory
pediatric
care
B: rating by patient of
diagnostic ability,
thoroughness, empathy
Piette,
2003
PRU V
P S, 0
Diabetes
B: rated by patient,
interpersonal process of care
Piette,
2005
PV
I, 0
Diabetes
N: rated by patients; Primary
Care Assessment Survey
Patient self-report
of contraceptive
use (greater than
80% or less than
80% protection)
Patient self-report
of use of
recommended
preventive
services
Return
appointmentkeeping
12 mos
median
338p
.10
0
961a
.05
8 days
242p
.30
Patient selfreport: diabetic
patients'
adherence to
meds, diet,
exercise, foot
care. Summary of
Diabetes SelfCare
Questionnaire
Patient self-report
of cost related to
underuse of
medications
0
752a
.09
0
912a
.10
Podell,
1976
PC
F, 1
Hypertension
V: rated independent review
based on chart, physician,
and patient interview;
“Success versus failure to
communicate with MD”
Pharmacy records
of medication and
control of blood
pressure
1 month
41a
.24
Politi,
2008
CS
P,0
Cancer
screening
V: behavior code: for each
screening test, women were
asked whether their primary
care providers (nurse
or doctor) explained the test
process in understandable
ways, and
how often they spoke to a
provider after the test about
the results.
These questions were each
coded on a scale from 0
(none of the
time) to 3 (all of the time).
and averaged and combined
into
one variable labeled
‘‘communication about the
tests."
Self reported on
time breast and
cervical cancer
screening
0 (retro--past
2 years
mammogram,
3 yrs pap)
605a
.08
Reed,
1984
PC
F, 48
Otitis Media B: rating; behavior of doctor
-Acute
and relationship with doctor
Remien,
2007
UCPS
S, 0
HIV
B: ratings by patients; 8 item
rating of perceptions of
interactions with providers
Romm,
1979
PU
IF, 42
Diabetes
B: rating by patient; attitudes
regarding personal and
professional qualities of
doctor
Rost, 1989 PV
I, 0
Chronic
disease
V: coding; mutual exchange,
bidirectional information
exchange
Safran,
1998
P,0
Various
diagnoses
B: rated; Primary Care
Assessment Survey; survey
questionnaire about
communication, trust,
humane treatment
PCS
Urine assay of
adherence to
prescription of 10
days amoxicillin;
Patient return for
follow-up
Self-reported
medication
adherence based
on percent taken
of prescribed pills
over 3 days
HP assessment of
diabetes control
status: level of
control of
diabetes
10 days
295a,p
.11
Over 3 days
188a
.17
6 mos
244a
.16
45a
.34
6014a
.29
Adherence to
3 mos
medications,
prescription
refills/pharmacy
records
Patient self-report 0
about following
advice re:
smoking, alcohol
use, diet, exercise,
seat belt use,
stress, safe sex
practices
Sanazaro,
1968
PU
P S, 2499
Internal
medicine
practice
Schneider,
2004
PC
S, 22
HIV
Sewitch,
2004
PC
S, 11
Sideris,
1986
RU
I, 25
Inflammatory
bowel
disease
Chronic
disease
Smith,
1987
PC
C, 0
Asthma
Spernak,
2007
PC
S, 0
post-op
cardiac
rehab
V: coded; critical incident
technique; Physician
communication coded from
physician reports of care
given
B: rating by patient of verbal
communication and trust
V: rated by patient;
Physician-Patient
Discordance Scale
V: coding; Physician
communication with patient
about regimen coded by
observers of the interaction
B: rated by parents; Postvisit questionnaire regarding
satisfaction with care and
doctor’s communication (in
both task and interpersonal
realms)
B: rating by patients; FalvoSmith Patient-Doctor
Interaction Scale
Physician
assessment/report
of patient
adherence
0
1683a
.36
Patient selfreport:
antiretroviral
medication
Patient self-report
on Morisky Scale
of adherence
0
554a
.16
2 wks
158a
.25
Patient self-report
of regimen
adherence
1-3 mos
40a
.20
Parent self-report
of medication
compliance
f/u interview
no time
specified
174p
.25
Self-reported
adherence on
RAND general
and specific
adherence
measures
0
92a
.36
Stanton,
1987
PH
P, 3
Hypertensio
n
V: rated; In-home Patient
interview re: physician
communication of
information
Stewart,
1984
PC
F, 24
General
Practice
care
V: verbal behavior coded;
Bales Interaction Process
Analysis
Tebbi,
1986
PC
S, 0
Cancer
B: rating by patient;
understanding of info and
satisfaction with doctor
Patient self-report 0
and pill count of
hypertension
medication
adherence; Self
Report Gen. Adh.
and Self-report
Med. Adherence
Scale
Patient self-report 10 days
from interviews:
medication
adherence (acute
and chronic
illnesses)
Pt./parent self2, 20, 50 wks
report of and
physical test/assay
of chemotherapy
medications for
child/adolescent
50a
.21
115a
.21
46p
.13
Tessaro,
2006
CS
P, 0
Colorectal
cancer
screening
Thom,
1999
PC
P, 20
Primary
care
Tinley,
2004
PC
P, 0
Van
Servellen,
2005
PC
S, 0
Breast
cancer
screening in
BRCA1/2
females
HIV
B: patient rated; 74-item
self-administered pt. survey:
Communication with a
health care provider: how
often provider gave them
enough
information to make good
decisions about health;
involved pt. in decisions
about their health care; how
often comfortable asking
their doctor for tests or
information
N: rated; Trust in Physicians
Scale
N: rating: interpersonal
aspects of care on
Adherence Determinants
Questionnaire
B: ratings by patient; quality
of doctor-patient relationship
and satisfaction
Respondents were
asked if they had
ever had each of
the
screening tests for
colorectal cancer
(yes or no) and
in accordance
with the U.S.
Preventive
Services Task
Force guidelines
0
824a
.11
Patient self-report
of adherence to
prescribed
medication
Patient self-report
of adherence to
mammography
6 months
281a
.11
2 yrs
112a
.26
Patient self-report
of medication
adherence over 4
days
4 days
85a
.34
Van
Wieringen
, 2002
PC
FC, 8
General
practice
child visits
B: coded; RIAS
Vinamaki,
1993
PNU
S, 0
Type I
Diabetes
N: ratings by patients;
doctor-patient relationship
and therapeutic relationship
as a source of safety
Wang,
2007
PCS
S, 0
HIV
Wartman,
1983
PRU
I, 0
Adult
medicine or
urgent care
Patients’ parents
interviewed in
home visit
regarding
compliance with
prescribed therapy
Diabetes control
glycosylated
hemoglobin A1C
3-5 days
87p
.22
2 mos
previousretrospective
100a
.10
B: rating by patient; trust and SR adherence to
confidence in his/her doctor meds previous 3
and Dr explained meds
days
0
181a
.14
B: rating by patients;
Understanding doctors’
instructions and satisfaction
with doctor-patient
interaction
0
515a
-.16
Patient self-report
of compliance
with medication
prescribed at visit
(patient
interviewed by
phone)
Williams,
1998
PNOU
S, 1
Diabetes
B: rating; modified Health
Climate Questionnaire
HbA1C measure
of diabetes
control (at time 3)
12 most
128a
.21
Winefield, PC
1995
F, 21
General
Practice
Patient self-report
of whether
followed doctor’s
recommendations
4 days
188a
.11
YiannaPU
Kopoulou,
2005
S, 0
High blood
pressure
B: patient ratings in
interview and phone; 6-item
post consultation
questionnaire; 9 items
telephone survey regarding
doctors’ attitudes toward the
patient, information given,
and making the patient feel
worthwhile
V: rating by patient in
interview; adequate
counseling and explaining of
high blood pressure
0
1000a
.10
Zandbelt,
2007
IS, 30
General
Internal
Med,
Rheumatolo
gy,
Gastroenter
ology
Patient self-report
of adherence to
use of antihypertension
medications
Self-reported
adherence after 2
weeks--4 item
medication
adherence scale
Brooks
2 wks
323a
.00
(zero
effec
t)
RPU
B: Coding; Specialists’
patient-centered
communication behaviors;
Patient-centered Behavior
Coding Instrument (PBCI)
a. Type of doctor: P = practicing physician (includes attending); R = resident, PR = both, M = med student, F
= fellow, N = includes nurses, O = includes other health professionals). Setting of study: U = university
clinic, C = Community Office Practice, H = HMO, V = Veterans hospital; can be more than one; S = survey
study (population based)
b. Specialty of MD: F = family practice or GP, I = Internal Medicine, S = Specialist, P = Primary Care, C =
Pediatrician; 0 = no info given. Number of doctors = 0 entered if information not given in the article.
c. Communication measure: V= verbal communication, task-oriented communication; N = nonverbal,
psychosocial; B = BOTH.
d. Time period to assess adherence: 0= cross-sectional correlational study (communication and adherence
measured same time); Any time period listed is denoted as a Longitudinal study
Appendix B. Articles included in meta-analysis of experimental studies (n=21) and details of studies used in meta-analysis.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Casebeer LL, Klapow JC, Centor RM, et al. An intervention to increase physicians' use of adherence-enhancing strategies
in managing hypercholesterolemic patients. Acad Med. 1999;74:1334-1339.
Cornuz J, Humair JP, Seematter L, et al. Efficacy of resident training in smoking cessation: a randomized, controlled trial
of a program based on application of behavioral theory and practice with standardized patients. Ann Intern Med.
2002;136:429-437.
Edwards A, Elwyn G, Hood K, et al. Patient-based outcome results from a cluster randomized trial of shared decision
making skill development and use of risk communication aids in general practice. Fam Pract. 2004;21:347-354.
Evans BJ, Kiellerup FD, Stanley RO, et al. A communication skills programme for increasing patients' satisfaction with
general practice consultations. Br J Med Psychol. 1987;60 ( Pt 4):373-378.
Ferreira MR, Dolan NC, Fitzgibbon ML, et al. Health care provider-directed intervention to increase colorectal cancer
screening among veterans: results of a randomized controlled trial. J Clin Oncol 2005;23:1548-1554
Inui TS, Yourtee EL, Williamson JW. Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann
Intern Med. 1976;84:646-651.
Joos SK, Hickam DH, Gordon GH, et al. Effects of a physician communication intervention on patient care outcomes. J
Gen Intern Med. 1996;11:147-155.
Khankari K, Eder M, Osborn CY, et al. Improving colorectal cancer screening among the medically underserved: a pilot
study within a federally qualified health center. J Gen Intern Med 2007;22:1410-1414
Kinmonth AL, Woodcock A, Griffin S, et al. Randomised controlled trial of patient centred care of diabetes in general
practice: impact on current wellbeing and future disease risk. The Diabetes Care From Diagnosis Research Team. Bmj.
1998;317:1202-1208.
Maiman LA, Becker MH, Liptak GS, et al. Improving pediatricians' compliance-enhancing practices. A randomized trial.
Am J Dis Child. 1988;142:773-779.
Ockene JK, Kristeller J, Goldberg R, et al. Increasing the efficacy of physician-delivered smoking interventions: a
randomized clinical trial. J Gen Intern Med 1991;6:1-8
Pill R, Stott NC, Rollnick SR, et al. A randomized controlled trial of an intervention designed to improve the care given in
general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour. Fam Pract.
1998;15:229-235.
Putnam SM, Stiles WB, Jacob MC, et al. Teaching the medical interview: an intervention study. J Gen Intern Med.
1988;3:38-47.
14.
15.
16.
17.
18.
19.
20.
21.
Qureshi NN, Hatcher J, Chaturvedi N, et al. Effect of general practitioner education on adherence to antihypertensive
drugs: cluster randomised controlled trial. BMJ 2007;335:1030
Schectman JM, Schorling JB, Nadkarni MM, et al. Can prescription refill feedback to physicians improve patient
adherence? Am J Med Sci. 2004;327:19-24.
Smith NA, Seale JP, Ley P, et al. Effects of intervention on medication compliance in children with asthma. Med J Aust.
1986;144:119-122.
Strecher VJ, O'Malley MS, Villagra VG, et al. Can residents be trained to counsel patients about quitting smoking? Results
from a randomized trial. J Gen Intern Med 1991;6:9-17
Theunissen NC, de Ridder DT, Bensing JM, et al. Manipulation of patient-provider interaction: discussing illness
representations or action plans concerning adherence. Patient Educ Couns. 2003;51:247-258.
Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000;6:245-253.
Thom DH, Tirado MD, Woon TL, et al. Development and evaluation of a cultural competency training curriculum. BMC
Med Educ. 2006;6:38.
Unrod M, Smith M, Spring B, et al. Randomized controlled trial of a computer-based, tailored intervention to increase
smoking cessation counseling by primary care physicians. J Gen Intern Med 2007;22:478-484
First
author,
year
Pt. Disease
Physician
Sample
Communication
Training
Casebeer,
1999
Hypercholesterolemia
Community
physicians
practicing in
Alabama
Cornuz,
2002
Smoking
cessation
Residents in
General
Internal
Medicine and
Family
Medicine
Training: Continuing
Medical Education
program involving 3
interactive audioconferences, chart
reminders,
discussions about
physician-patient
communication to
promote adherence
Educational program
based on Stages of
Change model,
behavioral therapy,
active learning
methods, with
standardized patient;
to learn to counsel
and help patients quit
smoking; control
docs got lectures on
hyperlipidemia
Intervention
Design and Unit of
Analysis
E=experimental
group, C=control
Randomized
experiment; analyses
at patient level: 14 E
docs; 14 C docs
Adherence
Measure
Num. of r
pts. (a=
adult;
p=peds)
Patients' selfreported
consumption of
dietary fats; 9
months follow-up
222a
.19
Randomized
experiment: 17 E
docs; 18 C docs:
analyses at patient
level (115 E pts.;
136 C pts, all
smokers)
Patient self-report of 251a
abstaining from
smoking at one year
follow up
.16
Edwards,
2004
Heart disease,
menopause,
menorragia,
prostatism
GP's newly in
practice in
South Wales
Evans,
1987
Various-general
practice
General
Practitioners
in practice in
Melbourne
Ferreira,
2005
Colorectal
cancer
screening
Veteran's
hospital residents,
attendings,
and nurse
practitioners
Practice based
training in shared
decision making with
simulated patients
(E) vs control group
simple risk
communication
Training in general
communication and
compliance skills;
Exp group attended 2
three hour seminars.
Health care providers
in the intervention
attended
a 2 hour workshop on
colorectal cancer
screening. Every 4 to
6 months, they
attended quality
improvement
workshops, received
group screening
rates, individualized
confidential
feedback, and
training on
improving
communication with
patients with limited
literacy skills.
Randomized with
cross-over design;
20 doctors each
group; analyses at
patient level
Patient's stated
intention to adhere
to treatment
747a
.06
20 Exp 20 Control
docs, randomly
assigned; analyses at
patient level
Patients
interviewed: selfreported desire to
comply
400a
.15
Random assignment
of health
professionals;
control group= 53
practitioners,
experimental group
=60; analyses done
with adjustments for
clustering of patients
within providers;
963 control and
1015 intervention
patients.
Medical records
were reviewed for
colorectal cancer
screening
recommendations
by physicians and
completion of
screening by patient
(averaged) . 6-18
months follow-up
1978a
.05
Inui, 1976
Hypertension in
general medical
clinic
Attending
physicians,
fellows,
residents, and
interns in
General
Medical Clinic
Teaching sessions
about dialogue with
patients regarding
hypertension control;
focus on the Health
Belief Model;
Control physicians
sent a letter with
information
Joos, 1996
Various chronic
diseases
VA staff
attendings and
internal
medicine
residents in
general
medical clinic
Experimental group
training using role
play, direct
observation, video
review--to elicit
patient concerns,
change
communication
behaviors; 4.5 hours
of training; Control
group training in
medical decision
making
Quasi-experimental
design; assignment
to Training or
Control depends on
day of the week
assigned to clinic;
Before and after
physician tutorial, or
control, assessed. 26
trained and 27
control doctors;
analyses at patient
level (53 C, 49E)
Random assignment;
pre-post design.
Analyses at patient
level: n=348 (209
E,191 C); 22 E docs,
20 C docs
Self-report of diet
adherence; home
visit pill assessment
at 8.5 weeks, and
appointment
compliance in clinic
records
102a
.09
Computerized
pharmacy records
and self reports of
patient medication
adherence; clinic
appointment
adherence assessed
from clinical
records of noshows/failed; 3
month follow-up
348a
.18
Khankari,
2007
Colorectal
cancer
screening
Primary care
residents and
practicing
physicians in
federally
funded clinic
Kinmonth,
1998
Diabetes II
General
practitioners
(England) and
their practice
nurses
Maiman,
1988
Otitis Media
Pediatricians
in practice
Physicians trained (1
hour) to provide
colorectal cancer;
physicians were
taught specific
communication skills
identified in health
literacy initiatives.
Single arm pre-test
post test design,
patient level
analysis; outcome
measured at one
year follow up, 8
physicians, 154
patients identified
with in depth chart
review (analysis at
patient level);
Physicians trained in Randomization
patient centered care between practice
and how to evaluate
teams--parallel
patients' lifestyle and group design with
psychological status
follow-up after a
year: analyses done
at Physician level on
41 practices (21 E
docs, 20 C docs)
Training in pediatric Physicians randomly
compliance
assigned; analyses
enhancing strategies: done at physician
TPM=Tutorial and
level (TPM(32);
printed matter;
MPM (27);Control
MPM=mailed printed (24); Test is of
matter; C= Control.
TPM>MPM>C
Chart review:
Physician
recommended
screening and
patient completed
screening
(combined result):
12 month follow-up
post intervention
154a
.25
Hemoglobin A 1c; 1
year follow-up data
610a
.08
Home interview 8
days after visit:
mother report of
adherence to giving
medications to child
771p
.33
Ockene,
1991
Smoking
cessation
Internal
Medicine and
Family
Practice
residents in
five primary
care university
clinics
Pill, 1998
Diabetes II
General
practitioners
and practice
nurses in
practice in
Great Britain
Physicians trained to
provide advice only,
brief patient centered
counseling, or
counseling plus
nicotine gum:
physicians taught
patient centered
counseling and selfmanagement
recommendations
and patient
encouragement
Three hour training
involving discussion
and demonstration
for GP's and nurses
trained to encourage
patient activation;
audiotape analysis,
follow up with
newsletter
Randomized control
trial (196 physicians
and 1286 patients)with pre-post
measures of
smoking rates (6
month outcome
data) analyses at
patient level
Pt self reported
smoking status changes in smoking
assessed by pt.
telephone interview
6 months
1286a
.06
Practices were
randomized 15E,
14C; analyses done
at patient level: 95
intervention, 95
control
Changes in
glycosolated
hemoglobin; 8-9
months after
training
190a
.08
Putnam,
1988
Various
Year 2
medical
residents in
clinic
Visits with patients
were tape recorded
and coded; then
audio review and
discussion of
listening, explaining,
and verbal response
modes in
interviewing. 3.7
hours in individual
training session.
After study
completed, control
group offered
training.
Intervention group
selected on basis of
month of rotation in
screening clinic; not
randomized. 11 E
docs , 8 C docs,
reports no
significant
differences-assigned r=0;
analyses at patient
level
Phone interview
with patients: selfreported adherence
to medication 1
week after visit,
recommended
behaviors;
appointment
adherence measured
with clinic records
268a
.00
Qureshi,
2007
High blood
pressure
General
practitioners
in six
randomly
selected
communities
in Karachi,
Pakistan.
Training with a
simple
educational package
for general
practitioners on
adherence to
antihypertensive
drugs. one day
intensive
training session;
included training in
satisfactory
consultation sessions
for patients, with
explanations of
treatment and use of
appropriate
communication
strategies.
Cluster randomized
controlled trial--178
patients with
hypertension taking
antihypertensive
drugs completed 6
weeks follow up; 78
general
practitioners. Patient
level analyses.
Correct dosing,
defined as
percentage of
prescribed doses
taken, measured
with
electronic
medication event
monitoring system
(MEMS)
bottle: up to six
weeks follow-up.
178a
.12
Schectman,
2004
Diabetes
Primary care
residents and
attending
physicians
Training involves
prescription refill
feedback about
patients, and
adherence education.
Non-randomized:
trained group vs.
comparison; trained
are self selected; 44
doctors attended
training; analyses
done at patient level.
6 mos. pharmacy
refill adherence to
medication
340a
.17
Smith,
1986
Asthma
Pediatricians
in practice in
asthma clinic
in Australia
Strecher,
1991
Smoking
cessation
Residents in
Internal
Medicine (6
programs),
Family
Medicine (3),
and Pediatrics
(2) (focus on
parents’
smoking)
Theunissen, Hyper-tension
2003
PhysicianTrainees in
General
PracticeNetherlands
Physician taught
adherence gaining
strategies, patient
education, and
assessment; Control
group- only
assessment
Tutorial which
involved training in
smoking cessation
counseling with
individual or group
follow-up and
videotape of
successful
counseling. Prompt
program involved
chart based
reminders for
physician.
Trained physicians in
communication skills
for the management
of hypertension.
Training involved
discussion, action
plans, understanding
patient's model of
illness
21 E docs; 23 C
docs; assessed
before and after
training- Random
assignment; analyses
based on 196
patients
Randomized design.
234 residents
randomized into one
of four groups:
Tutorial, Prompt,
Tutorial and Prompt,
Control. Three
groups averaged and
compared to Control
Analyses done at
patient level.
Self-report
217p
interview: asthma
medication
adherence to dosing:
follow up period
averaged 108 days
.22
Pt self report of
quitting smoking
with cotinine check;
self report assessed
by pt. telephone
interview 6 months
after training
659a
.04
10 physicians before
and after
randomized to
Training; analysis
done at patient level.
Self-report
questionnaire:
patient took steps to
make positive
changes in
managing blood
pressure by
adhering to
medication and
lifestyle; one month
later
108a
.16
Thom,
2006
Diabetes Hyper- Primary care
tension
physicians in
practice
Physician cultural
competency training
at 4 sites;
Experimental group
got training and
feedback, control
only feedback
Thom,
2000
Various general practice
Office based 7 hour
continuing education
workshop--content
developed from
several major
workshops --goal to
improve physicianpatient trust.
Primary care
physicians in
practice
Doctors recruitedNot Randomized to
2 groups; measured
before and after
training; analyses
done at Physician
level on 53
physicians
Randomized
experiment, 10
physicians to
experimental
intervention, 10 to
control; analyses
done at patient level
Change in patients'
Hemoglobin A 1c,
weight loss, and
blood pressure
change: 6 month
follow-up
429a
.01
Pt. self report- how
often they followed
physician's advice;
how often took all
or most medications
--at 6 mos. after
treatment
414a
.03
Unrod,
2007
Smoking
cessation
Practicing
primary care
physicians in
managed care
organization.
Smoking Cessation
Expert-System
Interventioncomputer tailored
intervention (40
minute training in
office)designed to
increase smoking
cessation counseling
by primary care
physicians.
Intervention effects
were tested in
sample
of 70 physicians and
518 of their patients.
Physicians and their
patients were
randomized
to either intervention
or control
conditions. analyzed
via generalized and
mixed linear
modeling
controlling for
clustering. Patient
level analyses.
Patients' smoking
behaviors
6 months postintervention.
measure on self
report abstinence 7
days; longest quit
attempt (in days)
Abstinence verified
with saliva-cotinine
(35% subsample).
465a
.07
Note. In these studies, the r effect size compares trained (intervention) versus control (or a specified linear trend) on the dependent
variable of patient adherence. For the studies of patient adherence as an outcome of communication skills training, only 3 of the 21
studies used physician as unit of analysis, which results in a finding based on a random effects model, and allows generalization of the
findings to like physicians and their patients. The remaining 18 studies used patient as the unit of analysis and this is a fixed effects
approach allowing generalization only to these physicians and patients.