Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity.
Disparities in HIV care and outcomes negatively affect Black and Hispanic patients. Features of clinical communication may be a factor. This study is based on coding transcripts of 404 routine outpatient visits by people with HIV at four sites, using a validated system. In models adjusting for site and patient characteristics, with provider as a random effect, providers were more "verbally dominant" with Black patients than with others. There was more discussion about ARV adherence with both Black and Hispanic patients, but no more discussion about strategies to improve adherence. Providers made more directive utterances discussing ARV treatment with Hispanic patients. Possible interpretations of these findings are that providers are less confident in Black and Hispanic patients to be adherent; that they place too much confidence in their White, non-Hispanic patients; or that patients differentially want such discussion. The lack of specific problem solving and high provider directiveness suggests areas for improvement.
Department of Health Services, Policy and Practice, Brown University, G-S121-7, Providence, RI, 02912, USA, michael_barton_laws@brown.edu.
M Barton
MB
Laws
Yoojin
Y
Lee
William H
WH
Rogers
Mary Catherine
MC
Beach
Somnath
S
Saha
P Todd
PT
Korthuis
Victoria
V
Sharp
Jonathan
J
Cohn
Richard
R
Moore
Ira B
IB
Wilson
D000328:Adult; D001741:Black or African American; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology* / Q000523:psychology; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D020380:Needs Assessment; D010817:Physician-Patient Relations; D044465:White People; D016903:Drug Monitoring
D019380:Anti-HIV Agents