title: Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients.
abstract: BACKGROUND
  Medication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence.
  
  
  METHODS
  We randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the roter interaction analysis system (RIAS).
  
  
  RESULTS
  There was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p=.004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p=0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p=0.039), emotional talk (26 vs. 18 statements, p<0.001), and probing of patient opinion (3 vs. 2 statements, p=0.009).
  
  
  CONCLUSIONS
  A brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence.
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Welch Center for Prevention, Epidemiology and Clinical Research, USA. Electronic address: mcbeach@jhmi.edu.
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.affiliation: Portland VA Medical Center, Portland, USA; Department of Medicine, Oregon Health Sciences University, Portland, USA.
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland, USA.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Department of Medicine, Wayne State University, Detroit, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Eggly
authors.affiliation: Department of Medicine, Wayne State University, Detroit, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohn
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharp
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D062405:Motivational Interviewing; D009819:Office Visits; D010817:Physician-Patient Relations; D016903:Drug Monitoring
keywords: Communication skills training; HIV/AIDS; Medication adherence