How do doctors address heart failure patients’ disclosures of medication adherence problems during hospital and primary care consultations? An exploratory interaction-based observational cohort study

OBJECTIVES: To investigate how doctors and self-managing older patients with heart failure (HF) discuss the patients' potential or ongoing medication adherence problems, and how such discussions evolve as patients transition from hospital to home, with particular focus on: (1) doctors' communicative actions aimed at addressing patient disclosures of adherence problems and (2) patients' feedback indicating whether their doctor's supportive actions were acceptable to them. DESIGN: Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient-doctor consultations, audio recorded for each patient at: (1) first ward visit in hospital, (2) discharge visit from hospital and (3) follow-up visit with general practitioner (GP). SETTING: Hospital and primary care, Norway (2022-2023). PARTICIPANTS: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs). RESULTS: Analysis of 74 consultations revealed that 25 HF patients disclosed 23 practical adherence problems indicating risks of unintentional non-adherence (eg, limited resources to manage medications) and 39 perceptual problems indicating risks of intentional non-adherence (eg, worries, negative experience or stance). Doctors addressed 79% of patients' disclosures by: (1) exploring the scope of the problem or (2) providing supportive actions to improve patients' ability or motivation to adhere. We calculated nearly five times higher odds for doctors to address patients' practical problems to their perceptual problems (OR 4.79, 95% CI 1.25 to 25.83). Unresolved problems included: (1) doctors addressed patients' disclosures, but patients signalled the supportive actions were unsuitable (37%) and (2) doctors left disclosures unaddressed (21%). CONCLUSIONS: In this explorative study, the doctors were more likely to address the patients' adherence problems associated with unintentional non-adherence risks than those associated with intentional non-adherence risks. Even when doctors attempted to address HF patients' medication adherence problems, half of the problems remained unresolved, usually because patients indicated that the doctor's suggestion to improve their situation was against their preference.