Provider communication style and treatment intensification in uncontrolled hypertension

Abstract

Rationale, Aims and Objectives: Provider decisions to intensify antihypertensive medications are usually based on clinical metrics (i.e., blood pressure control), but may also be based on patient provided information. When providers use a participatory questioning style, patients share more information and providers may identify barriers to blood pressure control other than an inadequate medication regimen, such as poor adherence. Providers may in turn focus on such barriers rather than intensify treatment. We examined how providers’ question style influenced their treatment intensification for uncontrolled hypertension.

Methods: We used qualitative and quantitative methods to analyze data from 43 audiorecorded clinical encounters. Transcripts were coded according to a priori categories including provider question style (open- and/or closed-ended) and whether treatment was intensified, as determined by interpretation of providers’ verbalizations. We used Fisher’s exact test to evaluate the association of provider questioning style with treatment intensification.

Results: Providers used a mix of open- and closed-ended questions less frequently than they used closed-ended questions alone. Treatment intensification was less common when a mix of questions was used instead of closed-ended questions alone, although this difference did not reach statistical significance (29% vs. 73% of instances, p=0.07).

Conclusions: Provider communication that invites patient participation may elicit more information about patient behavior, but may not impact decisions about treatment intensification in uncontrolled hypertension. Future studies should examine this question among a larger sample and investigate the relationship of participatory communication to improvements in blood pressure control.