Abstract
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.
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Acknowledgments
This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). 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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Callon, W., Saha, S., Korthuis, P.T. et al. Which Clinician Questions Elicit Accurate Disclosure of Antiretroviral Non-adherence When Talking to Patients?. AIDS Behav 20, 1108–1115 (2016). https://doi.org/10.1007/s10461-015-1231-7
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DOI: https://doi.org/10.1007/s10461-015-1231-7