On August 11, 2009, the New England Healthcare Institute (NEHI) published an article asserting that nonadherence to medications increases U.S. health care costs by $290 billion per year (NEHI, 2005). The article also states that “one third to one half of all patients do not take their medications properly.” These proportional levels are also supported by statistics available to the PATH Institute Corporation.
PATH Type Questionnaire and Healthcare Provider Distrust
The PATH Institute has recognized the adverse impacts of health care consumer and patient distrust on adherence since 2005. The PATH Type Questionnaire assesses adult patient distrust through questions which measure perceptions of health care provider competence. The integration of the PATH Type Questionnaire into patient satisfaction measurement at hospitals such as Stanford University Hospital and Vanderbilt Medical Center, and statewide Blue Cross Blue Shield health plans has consistently linked lower levels of satisfaction with the PATH Type Questionnaire measures indicating high patient distrust in health care providers.
Healthcare Provider Distrust and Medication Adherence
The 2005 study sponsored by Medical Marketing & Media magazine (MM&M, 2005) and conducted by MRx Health was the first study where patient distrust could be specifically linked to indicators of medication adherence. In the study of 546 adults, Question 9 asked: Have you ever stopped taking medications without talking to your doctor? Thirty-eight percent (38%) of adults said “yes”. This is in the ball park reported by the NEHI study. In the MM&M study sample which included responses to the PATH Type Questionnaire, 17% reported somewhat high distrust and 7% reported very high distrust in health care providers, totaling nearly a quarter of respondents. These distrust percentages are a little high compared to national estimates from the PATH Type Normative sample of 51,522 adults 18+ to 85 and over, which places the percentage of adults with medical provider distrust at about 16% (95CL + or - 0.3%).
What is the impact of patient distrust on medication adherence?
A cross-tabulation analysis of the association between the medication adherence indicator and the PATH Type Questionnaire items assessing provider distrust revealed that patient distrust has a highly significant and meaningful association with patient medication adherence, Chi Square (4, N = 546) = 24.6, p < .0001, Cramer’s V = .22. This last statistic indicates that patient medication adherence is firmly linked to patient distrust. Examination of the data revealed that at somewhat high distrust levels “yes” responses to the non-adherence question increased to 43.5%; at the very high distrust levels the rate of “yes” responses to the non-adherence question increased to 71.8%. This percentage is nearly twice the size of the original 38% who indicated nonadherence. These outcomes lend strong support to the positive relationship between medication nonadherence and implicit patient distrust of health care providers.
Patient Implicit Distrust in Health Providers and Medication Claims
The impact of healthcare provider distrust is also seen in median medication claims. A study with a statewide Blue Cross Blue Shield plan linked three years of pharmacy claims to response levels on PATH Type Questionnaire items. On the items measuring member distrust in health care providers those with high trust generated median Rx claims of about $400 per person per year, while those with high distrust generated median Rx claims of about $200 per person per year, Chi Square (4, N = 8,176) = 20.5, p < .0001, Cramer’s V = .025.
Implications
Current levels of implicit distrust in medical providers needs to be addressed along with other efforts to reduce medication non-adherence. This suggests that medical providers need access to efficient measures of patient predispositions like the PATH Type Questionnaire to effectively identify health care provider distrust levels among patients. This will allow them to improve identification of those patients with the distrust risk-factor to non-adherence. Armed with this information, health psychological interventions can be applied and tailored to patients to mediate and lower the impacts of health care provider distrust on medication adherence, which in turn will lower the billions of dollars lost to medication non-adherence.
References
Medical Marketing & Media [MM&M] (2005, June). How Will Patients Behave? A study of consumer preferences for seeking and using information. http://www.mmm-online.com/
New England Healthcare Institute [NEHI] (2005). NEHI Research Shows Patient Medication Nonadherence Costs Health Care System $290 Billion Annually. Cambridge, MA: NEHI. http://www.nehi.net/news/press_releases/110/nehi_research_shows_patient_medication_nonadherence_costs_health_care_system_290_billion_annually.
About the PATH Type Questionnaire
The PATH Type Questionnaire is a 20 item, 4 minutes behavioral assessment that measures schematic and aschematic behaviors and predispositions across numerous dimensions of health and health care including health information seeking, medical provider distrust, attention to family health, proactive health behavior, behavior around health care costs and quality, levels of vigorous exercise, attention to nutrition, use of alternative complimentary care, attention to health care advertising, and health care seeking. The PATH Type Questionnaire is appropriate for adults 18+ to 85 years and older living within the United States, including those who speak Spanish. The PATH Type Questionnaire can assess health behavior at the linear variable level, and at the nonlinear, person-centered, level through identification PATH Types which are constructs describing intra-personal implicit cognitive structure motivating health care behavior and perception.
