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Articles   |    
Appointment Length, Psychiatrists’ Communication Behaviors, and Medication Management Appointment Adherence
Mario Cruz, M.D.; Debra L. Roter, Dr.P.H.; Robyn F. Cruz, Ph.D., B.C.-D.M.T.; Melissa Wieland, Ph.D., M.P.H.; Susan Larson, M.S.; Lisa A. Cooper, M.D., M.P.H.; Harold Alan Pincus, M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200416
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Dr. Cruz is affiliated with the Department of Psychiatry, University of New Mexico School of Medicine, MSC09 5030, 1 University of New Mexico, Albuquerque, NM 87131 (e-mail: macruz@salud.unm.edu). Dr. Roter and Ms. Larson are with the Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Robyn F. Cruz is with the Division of Expressive Therapies, Lesley University, Boston. Dr. Wieland is with the Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Dr. Cooper is with the Johns Hopkins School of Medicine, Baltimore. Dr. Pincus is with the Department of Psychiatry, Columbia University, New York City.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The authors explored the relationship between critical elements of medication management appointments (appointment length, patient-centered talk, and positive nonverbal affect among providers) and patient appointment adherence.

Methods  The authors used an exploratory, cross-sectional design employing quantitative analysis of 83 unique audio recordings of split treatment medication management appointments for 46 African-American and 37 white patients with 24 psychiatrists at four ambulatory mental health clinics. All patients had a diagnosis of depression. Data collected included demographic information; Patient Health Questionnaire–9 scores for depression severity; psychiatrist verbal and nonverbal communication behaviors during medication management appointments, identified by the Roter Interaction Analysis System during analysis of audio recordings; and appointment adherence. Bivariate analyses were employed to identify covariates that might influence appointment adherence. Generalized estimating equations (GEEs) were employed to assess the relationship between appointment length, psychiatrist patient-centered talk, and positive voice tone ratings and patient appointment adherence, while adjusting for covariates and the clustering of observations within psychiatrists. Wald chi square analyses were used to test whether all or some variables significantly influenced appointment adherence.

Results  GEE revealed a significant relationship between positive voice tone ratings and appointment adherence (p=.03). Chi square analyses confirmed the hypothesis of a positive and significant relationship between appointment adherence and positive voice tone ratings (p=.03) but not longer visit length and more patient-centered communication.

Conclusions  The nonverbal conveyance of positive affect was associated with greater adherence to medication management appointments by depressed patients. These findings potentially have important implications for communication skills training and adherence research.

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Table 1Characteristics of 83 patients and 24 psychiatrists who participated in audio recordings of medication management appointments
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Table 2Characteristics of 83 patients and 24 psychiatrists who participated in audio recordings of medication management appointments, by adherence to a follow-up appointment
Table Footer Note

aMeans were compared by t test, and proportions were compared by chi square test.

Table Footer Note

bPatient Health Questionnaire–9. Possible scores range from 0 to 27, with higher scores indicating more severe depression.

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Table 3Relationship between characteristics of a medication management appointment and adherence to a follow-up appointment, by unadjusted and adjusted GEEa
Table Footer Note

aGeneralized estimating equations

Table Footer Note

bAdjusted for patient race, psychiatrist gender, clinic, race concordance, and patient income

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