Fourth, medication adherence was assessed with a self-report measure, which lacks a time
frame for patients to refer to when responding to each of the questions. This may have led to
an overestimation of adherence levels due to patient recall bias. However, our data show a
non-adherence rate of 59%, which is similar to the estimated 50 to 70% non-adherence rates
in the literature (24). Moreover, the Morisky scale was found to have a sensitivity of 72%
with a specificity of 74% for adherence to at least 80% of prescribed antihypertensive
medications(33) and was associated with better blood pressure control in hypertensive
patients.(33, 65) Future studies would benefit from also utilizing a more objective measure
of adherence to assess the relationship between patient-provider communication and
medication adherence. Finally, provider communication was assessed as patients’ selfreported
perception of the interaction; thus, scores may reflect characteristics specific to the
patient (i.e., personality traits), rather than the actual dialogue. Despite this limitation, the
importance of understanding the patient’s perspective of the patient-provider relationship
cannot be understated.