title: Provider-patient adherence dialogue in HIV care: results of a multisite study.
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.
authors.affiliation: Department of Health Services Policy and Practice, Brown University, G-S121-7, Providence, RI 02912, USA. Michael_Barton_Laws@Brown.edu
authors.forename: M Barton
authors.initials: MB
authors.lastname: Laws
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharp
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000451:nursing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D005791:Patient Care; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D013637:Tape Recording; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents