Authors: Wynne Callon Somnath Saha P Todd Korthuis Ira B Wilson Richard D Moore Jonathan Cohn Mary Catherine Beach
Publish Date: 2015/10/26
Volume: 20, Issue: 5, Pages: 1108-1115
Abstract
This study evaluated how clinicians assess antiretroviral ARV adherence in clinical encounters and which questions elicit accurate responses We conducted conversation analysis of audiorecorded encounters between 34 providers and 58 patients reporting ARV nonadherence in postencounter 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 nonadherence 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 positivelyframed “Are you taking your medications regularly” 4 negativelyframed “Have you missed any doses” Clinicians asked 75 ARVrelated questions 23 clarification 12 broad 17 positivelyframed and 23 negativelyframed Negativelyframed questions were 38 times more likely to elicit accurate disclosure than all other question types p 00001 Providers can improve disclosure probability by asking directly about missed dosesThis research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality AHRQ 290010012 In addition Dr Korthuis was supported by the National Institute of Drug Abuse K23 DA019809 Dr Saha was supported by the Department of Veterans Affairs Dr Beach was supported by the National Institute of Drug Abuse K24 DA037804 None of the funders had a role in the design and conduct of this analysis nor was it subject to their final approval None of the authors have any relevant financial conflicts of interest
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