Patient?Clinician Relationships and Treatment System Effects on HIV Medication Adherence

Abstract

The study objectives were to determine the impact of the patient-clinician relationship on patient adherence to HIV medication, to identify which aspects of the patient-clinician relationship and the treatment system influenced adherence, and to determine which of these variables remained important when the impact of mental distress and substance abuse were considered. The design was a cross-sectional study using a sample of 120 HIV+ clinic patients. The Primary Care Assessment Survey (PCAS) assessed the clinician-patient relationship and the treatment system. The Composite International Diagnostic Inventory-Short Form (CIDI-SF) screened for mental disorders, and the Brief Substance Abuse History Form measured recent and remote substance use. Patient adherence was assessed using five markers including 3 interview-elicited self-reports, 1 medical chart review, and 1 summary score. Logistic regression analyses identified independent predictors of each adherence behavior. PCAS scores contributed to all five models, and their effects persisted when mental distress and substance abuse were considered. Adherence behaviors are explained by a variety of factors and should be assessed using multiple methods. Further study to illuminate the mechanisms of action of the clinician-patient relationship on adherence to HIV medication is warranted.

A Test of Motivational Plus Nicotine Replacement Interventions for HIV Positive Smokers

“…Similarly, Cooper et al (2004) found that patch use was associated with better treatment participation and cessation outcomes, and that perfect adherence occurred in only one-third of participants. Likewise, adherence problems have been noted among HIV patients in other areas as well (Ingersoll 2004;Ingersoll and Heckman 2005). Smoking interventions should probably contain NRT adherence-enhancing components.…”

Patient-related Factors Predicting HIV Medication Adherence among Men and Women with Alcohol Problems

“…A quality patient-provider relationship has also been identified as an important source of support to promote adherence to HIV medication (Ingersoll & Heckman, 2005;Martini, Parazzini, & Agnoletto, 2001;Roberts, 2002) as well as the perception of the provider as open, respectful, empathic and showing genuine interest (Simoni et al, 2003). For example, in a qualitative study of 28 HIV-positive persons, the need for trust in their physicians was commonly identified (Roberts, 2002).…”

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

“…The strength of patient-provider relationships is associated with greater patient trust and self-efficacy, and in turn, a higher likelihood of patients' receiving ARV therapy, adhering to ARV regimens, and achieving favorable virologic outcomes. [16][17][18][19][20] Unfortunately, many minority patients face a disadvantage in establishing strong relationships with their providers. Most minorities in the U.S. see providers from racial and ethnic groups different from their own.…”