title: Provider-focused intervention increases adherence-related dialogue but does not improve antiretroviral therapy adherence in persons with HIV.
abstract: BACKGROUND
  Physicians' limited knowledge of patients' antiretroviral adherence may reduce their ability to perform effective adherence counseling.
  
  
  METHODS
  We conducted a randomized, cross-over study of an intervention to improve physicians' knowledge of patients' antiretroviral adherence. The intervention was a report given to the physician before a routine office visit that included data on Medication Event Monitoring System and self-reported data on antiretroviral adherence, patients' beliefs about antiretroviral therapy, reasons for missed doses, alcohol and drug use, and depression. We audio recorded 1 intervention and 1 control visit for each patient to analyze differences in adherence-related dialogue.
  
  
  RESULTS
  One hundred fifty-six patients were randomized, and 106 completed all 5 study visits. Paired audio recorded visits were available for 58 patients. Using a linear regression model that adjusted for site and baseline Medication Event Monitoring System adherence, adherence after intervention visits did not differ significantly from control visits (2.0% higher, P = 0.31, 95% confidence interval: -1.95% to 5.9%). There was a trend toward more total adherence-related utterances (median of 76 vs. 49.5, P = 0.07) and a significant increase in utterances about the current regimen (median of 51.5 vs. 32.5, P = 0.0002) in intervention compared with control visits. However, less than 10% of adherence-related utterances were classified as "problem solving" in content, and one third of physicians' problem-solving utterances were directive in nature.
  
  
  CONCLUSIONS
  Receipt of a detailed report before clinic visits containing data about adherence and other factors did not improve patients' antiretroviral adherence. Analyses of patient-provider dialogue suggests that providers who care for persons with HIV may benefit from training in adherence counseling techniques.
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA. iwilson@tuftsmedicalcenter.org
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Michael Barton
authors.initials: MB
authors.lastname: Laws
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.forename: Minyi
authors.initials: M
authors.lastname: Lu
authors.forename: William
authors.initials: W
authors.lastname: Coady
authors.forename: Paul R
authors.initials: PR
authors.lastname: Skolnik
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001291:Attitude of Health Personnel; D018592:Cross-Over Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents