Which Clinician Questions Elicit Accurate Disclosure of Antiretroviral Non-adherence When Talking to Patients?
This study evaluated how clinicians assess antiretroviral (ARV) adherence in clinical encounters, and which questions elicit accurate responses. We conducted conversation analysis of audio-recorded encounters between 34 providers and 58 patients reporting ARV non-adherence in post-encounter interviews. Among 42 visits where adherence status was unknown by providers, 4 providers did not discuss ARVs (10 %), 6 discussed ARVs but did not elicit non-adherence disclosure (14 %), and 32 discussed ARVs which prompted disclosure (76 %). Questions were classified as: (1) clarification of medication ("Are you still taking the Combivir?"); (2) broad ("How's it going with your meds?"); (3) positively-framed ("Are you taking your medications regularly?"); (4) negatively-framed ("Have you missed any doses?"). Clinicians asked 75 ARV-related questions: 23 clarification, 12 broad, 17 positively-framed, and 23 negatively-framed. Negatively-framed questions were 3.8 times more likely to elicit accurate disclosure than all other question types (p < 0.0001). Providers can improve disclosure probability by asking directly about missed doses.
Johns Hopkins University School of Medicine, Baltimore, MD, USA. wcallon1@jhmi.edu.
Wynne
W
Callon
Portland VA Medical Center, Portland, OR, USA.|Department of Medicine, Oregon Health Sciences University, Portland, OR, USA.
Somnath
S
Saha
Department of Medicine, Oregon Health Sciences University, Portland, OR, USA.
P Todd
PT
Korthuis
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Ira B
IB
Wilson
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Richard D
RD
Moore
Department of Medicine, Wayne State University, Detroit, MI, USA.
Jonathan
J
Cohn
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mary Catherine
MC
Beach
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003142:Communication; D030881:Disclosure; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D005791:Patient Care; D010817:Physician-Patient Relations; D015215:Zidovudine / Q000627:therapeutic use; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D004338:Drug Combinations; C109078:lamivudine, zidovudine drug combination; D019259:Lamivudine; D015215:Zidovudine
Adherence; Antiretrovirals; HIV/AIDS; Physician-patient communication