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Patient-Provider Dialogue With HIV Drugs

Patient-Provider Dialogue With HIV Drugs

Research has shown that race and ethnicity may be associated with differences in how healthcare providers communicate with patients. “In HIV, a key component to outcomes is adherence to antiretroviral therapy (ART),” says Michael Barton Laws, PhD, MA. “Investigators have hypothesized that clinical communication may be a factor in how well or poorly HIV patients adhere to ART regimens.” Examining Themes In a study published in AIDS and Behavior, Dr. Laws and colleagues reviewed more than 400 routine outpatient visits by people with HIV. Three themes emerged from the analysis of patient–provider conversations, depending on patients’ race and ethnicity: 1) Speech patterns: African Americans spoke less to their providers than Caucasians or Hispanics. Hence, there was greater provider verbal dominance in their discussions. They also less frequently expressed their goals or values. Healthcare providers asked Hispanics fewer open-ended questions. 2) ART adherence: Visits with African-American and Hispanic patients included more dialogue about adherence than visits with Caucasian patients. This difference occurred regardless of how adherent patients reported being to their ART regimens or whether laboratory tests showed that HIV was under control. 3) Problem solving: The more extensive dialogue about ART adherence between patients and healthcare providers was directive rather than problem solving. “There was more discussion about ART adherence with African Americans and Hispanics,” adds Dr. Laws, “but no more discussion about strategies to improve adherence.”   Possible Interpretations Dr. Laws says that several factors may influence why healthcare providers talked more with minority patients than with Caucasians about adherence. “It’s possible that healthcare providers are trying to compensate for what they’ve seen in studies about lower adherence...

Guidelines: Improving Retention & Treatment Adherence in HIV

Patient adherence to antiretroviral therapy (ART) is one of the most impor­tant factors associated with successful HIV outcomes. Following a diagnosis, timely entry into HIV medical care is essential to the provision of ART. However, of the approxi­mately 1.2 million people in the United States with HIV, only 69% are linked to care. For those who start care, only about 59% are retained in care. Among people with HIV who are on ART, just 28% have undetectable viral loads, which indicate high adherence to therapy. The varied and complex evidence base resulting from more than 20 years of research in these areas had until recently not been fully evaluated. In an effort to improve entry and retention in care as well as ART adherence in patients with HIV, a guidelines committee sponsored by the International Association of Physicians in AIDS Care and the NIH Office of AIDS Research published evidence-based guidelines in the Annals of Internal Medicine. Click here to view the full guidelines. Key Recommendations Melanie A. Thompson, MD, who was the lead author of the guideline document, says that the recommenda­tions set a high bar for meeting the standard of evidence. “We systematically reviewed literature from domestic and international studies that have been published since 1996,” she says. After reviewing 325 randomized controlled trials and observational studies that met stringent criteria for high-quality, comparative evidence, the expert panel arrived at 37 recommendations to assist clinicians in their care of people with HIV, several of which are particularly notable (Table 1). “All patients should receive some form of one-on-one ART education and adherence support.” According to Dr. Thompson,...

Strategies to Improve Medication Adherence

According to recent estimates, about a third to a half of all patients in the United States fail to comply with their prescribed pharmacotherapy regimens. Failure to adhere to medications can reduce quality of care and increase medical expenses. Costs attributable to non-adherence are about $290 billion each year, and much of this spending stems from complications that result from not taking medications appropriately. “Patients fail to take their medications for many reasons, including difficulty with dosing regimens, costs, side effects, or concerns about drugs in general,” says Walid F. Gellad, MD. “Providers need different strategies and interventions to improve adherence.” To achieve optimal medication adherence, considerations must be made with regard to effective patient-provider communication, coordination among care providers, and active engagement and participation by patients. “All too often, patients are lacking important information or there are gaps in their communication with providers,” Dr. Gellad says. “For these reasons, it’s critical to identify any opportunities to remove barriers that keep patients from adhering to their medications.” New Policy Recommendations On July 15, 2009, several organizations convened more than 40 experts to discuss poor medication adherence in the United States, including GlaxoSmithKline, the National Association of Chain Drug Stores Foundation, the National Consumers League, the Pharmaceutical Research and Manufacturers of America, and the American College of Cardiology. As a result of this meeting, consensus policy recommendations to reduce barriers to adherence were released on October 14, 2009. Using themes that emerged from the July 15, 2009 conference and considering the proposed policies under review by Congress, the resulting recommendations focus on the following key areas: quality improvement strategies, care...
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