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Provider-patient Adherence Dialogue in HIV Care: Results of a Multisite Study

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Abstract

Few studies have analyzed physician–patient adherence dialogue about ARV treatment in detail. We comprehensively describe physician–patient visits in HIV care, focusing on ARV-related dialogue, using a system that assigns each utterance both a topic code and a speech act code. Observational study using audio recordings of routine outpatient visits by people with HIV at specialty clinics. Providers were 34 physicians and 11 non-M.D. practitioners. Of 415 patients, 66% were male, 59% African–American. 78% reported currently taking ARVs. About 10% of utterances concerned ARV treatment. Among those using ARVs, 15% had any adherence problem solving dialogue. ARV problem solving talk included significantly more directives and control parameter utterances by providers than other topics. Providers were verbally dominant, asked five times as many questions as patients, and made 21 times as many directive utterances. Providers asked few open questions, and rarely checked patients’ understanding. Physicians respond to the challenges of caring for patients with HIV by adopting a somewhat physician-centered approach which is particularly evident in discussions about ARV adherence.

Resumen

Pocos estudios han analizado en detalle el diálogo entre médicos y pacientes sobre la adherencia del paciente al tratamiento con antirretrovirales (ARVs). Se describe globalmente encuentros entre médicos y pacientes en el tratamiento del VIH, con enfoque en el diálogo sobre ARVs, usando un sistema que aplica a cada enunciado un código para el tema, y para el acto de del habla.Estudio observaciónal con uso de grabaciones de consultas externas rutinarias de personas con VIH en clínicas especializadas.Los proveedores fueron 34 médicos y 11 proveedores de otras clases. De 415 pacientes, 66% fueron hombres, 59% Africano-Americanos. 78% informaron tomar ARVs actualmente.Aproximadamente 10% de los enunciados se refirieron al tratamiento con ARVs. Entres los que usaron ARVs, 15% tuvieron algún diálogo sobre la resolución de problemas de adherencia al tratamiento. El diálogo sobre la resolución de problemas incluyó significativamente más actos directivos y enunciados en la clase de control, comparado a otros temas. Los proveedores dominaron la conversación, hicieron 5 veces más preguntas que los pacientes, y 21 veces más enunciados directivos. Los proveedores hicieron pocas preguntas abiertas, y raras veces chequearon el entendimiento del paciente.Los médicos responden al reto de atender a los pacientes con VIH adoptando un acercamiento que se centra en el médico, lo que se evidencia particularmente en la discusión sobre la adherencia al tratamiento con ARVs.

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Acknowledgments

This research was supported by award numbers R34MH089279; and R01MH083595 from the National Institute Of Mental Health; and by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). In addition, Dr. Korthuis was supported by the National Institute of Drug Abuse (K23 DA019809), Dr. Saha was supported by the Department of Veterans Affairs, Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05) and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. Dr. Wilson was supported by the National Institute of Mental Health (2 K24MH092242). The views expressed here are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. We gratefully acknowledge the contributions of Emily Howe, Tatiana Taubin, M. A., Tanya Bezreh, M. A., Ylisabyth Bradshaw, D. O., and Amanda Barrett, M. A. to development of the GMIAS and coding for this study.

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Authors and Affiliations

  1. Department of Health Services Policy and Practice, Brown University, G-S121-7, Providence, RI, 02912, USA

    M. Barton Laws & Ira B. Wilson

  2. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Mary Catherine Beach

  3. Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA

    Yoojin Lee & William H. Rogers

  4. Oregon Health and Science University, Portland, OR, USA

    Somnath Saha & P. Todd Korthuis

  5. St. Luke’s-Roosevelt Hospital, New York, NY, USA

    Victoria Sharp

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  1. M. Barton Laws
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  8. Ira B. Wilson
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Correspondence to M. Barton Laws.

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Laws, M.B., Beach, M.C., Lee, Y. et al. Provider-patient Adherence Dialogue in HIV Care: Results of a Multisite Study. AIDS Behav 17, 148–159 (2013). https://doi.org/10.1007/s10461-012-0143-z

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