The doctor patient relationship and adherence to medication: Empirical investigations in Greece and a game theory approach.

Non-adherence to medication is a problem of great magnitude as it leads to reduced health outcomes and increased health care costs. The impact of the doctor-patient relationship on non-adherence has attracted the interest of researchers yet relevant evidence is limited. The aim of this thesis is twofold. It empirically investigates the relationship between the doctor-patient interaction and non-adherence to medication in Greece, on a population and a patient level. It also develops a theoretical model of the doctor-patient relationship using non-cooperative game theory to explain how supply of information under conflict conditions affects non-adherence. Two empirical studies and a game theoretical model are used. The first study draws on data from the European Social Survey to examine beliefs about doctors and attitudes towards medication in the general population. The second study analyses a questionnaire survey of hypertensive patients in Greece, conducted for this thesis. The game theoretical approach investigates how conflicts between patients' preferences for information and doctors' effort to supply it may lead to non-adherence. It employs concepts from Behavioural Economics, which combines elements of both Economics and Psychology. The findings demonstrate a strong association between what individuals think of doctors and their attitudes towards medication. Beliefs about doctors are the strongest predictors of non-adherence in both studies. At a population and patient level, Greeks attach a lot of weight to their doctors' opinions and adhere to their recommendations. Finally, the game-theoretical framework shows that doctors' failure to understand patients' need for information may result in patients not adhering. The findings suggest that interventions to improve adherence rates should be built on the basis of a good doctor-patient relationship, where the doctors understand patients' needs, discuss about the treatment and pass on adequate information. The thesis is part of the cumulative knowledge in the area and could lead to further empirical and theoretical investigations