The adherence support gap: the 'ideal' versus 'reality' of antiretroviral adherence support provided by HIV health providers in clinical practice.
BACKGROUND
Guidelines suggest that clinicians should provide their patients with antiretroviral adherence support, but there is uncertainty about the types of adherence support clinicians think are important, the methods they use to provide adherence support, and the barriers they face in providing such support in clinical practice.


OBJECTIVE
To study clinician perspectives on the importance of different antiretroviral adherence support activities and compare these with clinicians' self-reported actual adherence support practices.


METHODS
From March to August 2005, surveys were mailed to physicians, pharmacists, and nurses who provide care to HIV patients in Ontario, Canada. The 84-item survey asked providers to rate how necessary it was to provide 30 types of adherence support activities and how frequently they actually provided each of the types of adherence support. From this, we assessed healthcare provider perceptions of best or ideal practices in supporting medication adherence and actual or usual care in adherence support provision. We also examined whether an adherence support gap existed between the provision of best practice adherence support and actual adherence support in clinical practice.


RESULTS
One hundred sixty-nine of 300 mailed surveys were returned, for a response rate of 56%. Respondents were highly specialized in HIV care and nearly all practiced in urban settings. Respondents indicated that most of the surveyed adherence support activities should be provided to all patients. However, most clinicians did not actually provide these adherence supports to their patients to the extent that they desired. We calculated an adherence support gap that ranged from 31% to 75% across the different types of adherence support activities.


CONCLUSIONS
We observed important adherence support gaps between ideal best practices in the provision of adherence support and actual provision of adherence support in clinical practice.
Park-Wyllie
Laura Y
LY
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. parkwylliel@smh.toronto.on.ca
Kam
Derek
D
Bayoumi
Ahmed M
AM
D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003625:Data Collection; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D009726:Nurses / Q000458:organization & administration / Q000523:psychology; D009864:Ontario / Q000453:epidemiology; D010595:Pharmacists / Q000458:organization & administration / Q000523:psychology; D010820:Physicians / Q000458:organization & administration / Q000523:psychology; D011787:Quality of Health Care; D019037:Urban Health Services / Q000706:statistics & numerical data; D016903:Drug Monitoring
D019380:Anti-HIV Agents