By the time American adults reach middle age, many are already dealing with chronic medical conditions such as type 2 diabetes or high blood pressure . Often, controlling these chronic illnesses means a lifetime of prescription medications. The cost of prescription drugs can be a difficult burden and can lead patients to take less medication than they should.

Surprisingly, however, most patients with chronic illnesses say that they do take their medications as prescribed, even when they have low incomes and lack prescription drug coverage. It seems that even for patients facing financial pressures, factors other than cost of medications can influence their decisions about whether to take their medications as prescribed.

An article published in the August 8/22, 2005 issues of Archives of Internal Medicine suggests that one of these factors might be the relationship between patients and their physicians. Researchers report that patients with a high level of trust in their physicians were much less likely to skip medications due to cost compared to patients who expressed a low level of trust in their physicians. In other words, patients under financial constraints considered the quality of the doctor-patient relationship as a factor in deciding whether to skip their medications or take them as prescribed.

About the Study

The data for this study were collected as part of a larger, multi-center study examining the quality of care for diabetic patients enrolled in the Department of Veterans Affairs (VA) health care system. As part of the multi-center study, patients were asked to complete a written survey.

This study’s researchers collected survey data on 912 patients. The survey asked how much patients paid out of pocket each month for their prescription medications and grouped the responses as: less than $51, $51 to $100, or more than $100. The survey also asked if the patients had ever taken less of any medication prescribed by their physician because of the cost, or for any reason other than the cost.

The patients were also asked about their level of trust in their physician. Based on their responses to five questions, the patients were categorized into either a high-trust or low-trust group.

Patients’ demographic data, including age, education, race, and income level was also collected. Annual income level was categorized as less than $10,000, $10,000 to $14,999, $15,000 to $24,999, and $25,000 or more.

Finally, patients answered questions that enabled the researchers to identify those that were likely to suffer from depression.

The researchers examined how physician trust, monthly out-of-pocket expenses, income level and depression affected medication compliance.

The Findings

Among patients with the highest monthly drug costs (more than $100), 11% of those with high levels of trust in their doctors skipped medications due to cost compared with 30% of patients with low levels of trust.

Medication compliance did not differ significantly between income levels in patients who had a high level of trust in their doctors. However, among patients with a low level of trust in their physicians, patients with annual incomes of less than $10,000 were significantly more likely to skip medications due to cost than patients with annual incomes of more than $25,000.

Patients with monthly prescription costs of more than $100 were significantly more likely to skip medications due to cost than patients with monthly prescription costs of less than $51, regardless of physician trust levels.

Finally, patients with significant symptoms of depression were twice as likely to skip medications because of cost compared to patients without depression.

How Does This Affect You?

This study found that patients who trust their doctors are much more likely to take their medications as prescribed, even when paying for those drugs becomes difficult.

While most physicians have implicit faith in the therapeutic benefit of the medicines they prescribe, they give comparatively little credence to the therapeutic benefits (or harms) of the relationships they cultivate with their patients. The most powerful medication on earth is useless if the patient fails to take it. Physicians who do not earn the trust of their patients are wasting the pages of their prescription pad.

This study supports what has long been suspected, a quality relationship between patient and physician is key to the success of every clinical encounter. Without trust, the system begins to break down under the inevitable pressures of costs and a myriad of other factors contriving against a successful prescription.