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.
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Bakken, S., Holzemer, W. L., Brown, M. A., Powell-Cope, G. M., Turner, J. G., Inouye, J., Nokes, K. M., and Corless, I. B. (2000). Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS, 14, 189–197.
Balint, J., and Shelton, W. (1996). Regaining the initiative: Forging a new model of the patient–physician relationship. Journal of the American Medical Association, 275, 887–891.
Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. A., Roberston, M., Zolopa, A. R., and Moss, A. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15, 1181–1183.
Battegay, M., Weber, R., Willi, J., Eich, D., Siegenthaler, W., and Luthy, R. (1991). Exploring the doctor–patient relationship reduces staff stress and enhances empathy when caring for AIDS patients. Psychotherapy and Psychosomatics, 56, 167–173.
Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., and McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.
Chesney, M. A., Morin, M., and Sherr, L. (2000). Adherence to HIV combination therapy. Social Science and Medicine, 50, 1599–1605.
Cook, R. L., Serelka, S. M., Hunt, S. C., Woodward, W. C., Erlen, J. A., and Conigliaro, J. (2001). Problem drinking and medication adherence among persons with HIV infection. Journal of General Internal Medicine, 16, 83–88.
DeOlalla, P., Knobel, H., Carmona, A., Guelar, A., Lopez-Colomes, J., and Cayla, J. (2001). Impact of adherence on highly active antiretroviral therapy on survival in HIV-infected patients. Journal of Acquired Immune Deficiency Syndrome, 30, 105–110.
DiMatteo, M. R. (1994). Enhancing patient adherence to medical recommendations. JAMA, 271, 79–83.
DiMatteo, M. R., Giordani, P. J., Lepper, H. S., and Croghan, T. W. (2002). Patient adherence and medical treatment outcomes: A meta-analysis. Medical Care, 40, 794–811.
Dunbar-Jacob, J. (2002, April). Adherence: Perspective on the individual. Master lecture presented at the Society of Behavioral Medicine 23rd annual meeting and scientific sessions, Washington, DC.
Duong, M., Piroth, L., Grappin, M., Forte, F., Peytavin, G., Boisson, M., Chavanet, P., and Portier, H. (2001). Evaluation of the patient medication adherence questionnaire as a tool for self-reported adherence assessment in HIV-infected patients on antiretroviral regimens. HIV Clinical Trials, 2, 128–135.
Flandre, P., Peytavin, G., Meiffredy, V., Saidi, Y., Descamps, D., Delagnes, M., Brun-Vezinet, F., Raffi, F., and the Trilege Study Team. (2002). Adherence to antiretroviral therapy and outcomes in HIV-infected patients enrolled in an induction/maintenance randomized trial. Antiviral Therapy, 7, 113–121.
Goldstein, M. G. (2002, April). Building relationships and promoting partnerships: Creating bonds to strengthen adherence. Presidential address given at the Society of Behavioral Medicine 23rd annual meeting and scientific sessions, Washington, DC.
Hogg, R. S., Heath, K., Bangsberg, D., Yip, B., Press, N., O’Shaughnessy, M. V., and Montaner, J. S. (2002). Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS, 16, 1051–1058.
Ingersoll, K. (2004). The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment. AIDS Care, 16, 199–211.
Institute of Medicine. (1994). Defining primary care: An interim report. Washington, DC: National Academy Press.
Kaplan, S. H., Greenfield, S., and Ware, G. E. (1989). Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Medical Care, 27(Suppl.), S110–S127.
Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., and Wittchen, H.-U. (1998). The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171–185.
Knobel, H., Alonso, J., Casado, J. L., Collazos, J., Gonzalez, J., Ruiz, I., Kindelan, J. M., Carmona A., Juega, J., and Ocampo, A. (2002). Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: The GEEMA study. AIDS, 16, 605–613.
Liu, H., Golin, C. E., Miller, L. G., Hays, R. D., Beck, C. K., Sanandaji, S., Christian, J., Maldonado, T., Duran, D., Kaplan, A. H., and Wenger, N. S. (2001). A comparison study of multiple measures of adherence to HIV protease inhibitors. Annals of Internal Medicine, 134, 968–977.
Lucas, G. M., Gobo, K. A., Chaisoon, R. E., and Moore, R. D. (2002). Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS, 29, 767–774.
Martini, M., Parazzini, F., and Agnoletto, V. (2002). Adherence to HIV treatment: Results from a 1-year follow-up study. HIV Medicine, 3, 62–64.
National Institute on Drug Abuse (NIDA). (1993). Drug History Form. In How good is your drug abuse treatment program? Resource manual (pp. RS3–40–RS3-41). Rockville, MD: NIDA.
Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E., Squier, C., Wagener, M. M., and Singh, N. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.
Rabkin, J. G., and Chesney, M. (1999). Treatment adherence to HIV medications: The Achilles heel of the new therapeutics. In D. Ostrow and S. Kalichman (Eds.), New HIV therapies: Psychological and public health implications (pp. 61–82). New York: Plenum Press.
Roberts, K. J., and Volberding, P. (1999). Adherence communication: A qualitative analysis of physician–patient dialogue. AIDS, 13, 1771–1778.
Safran D. G., Taira D. A., Rogers W. H., et al., (November 1996). Primary care performance in traditional and managed care systems. Presented at Annual Meeting of the American Public Health Association, New York.
Safran, D. G., Kosinski, M., Tarlov, A. R., Rogers, W. H., Taira, D., Lieberman, N., and Ware, J. E. (1998). Primary Care Assessment Survey: Test of data quality and measurement performance. Medical Care, 36, 728–739.
Sanson-Fisher, R. W., Campbell E. M., Redman, S., and Hennikus, D. J. (1989). Patient–provider interactions and patient outcomes. Diabetes Education, 15, 134–138.
Simpson, M., Buckman, R., Stewart, M., Maguire, P., Lipkin, M., Novack, D., and Till, J. (1991). Doctor–patient communication: The Toronto consensus statement. BMJ, 303, 1385–1387.
Singh, N., Squier, C., Sivek, C., Wagener, M., Hong Nguyen, M., and Yu, V. L. (1996). Determinants of compliance with antiretroviral therapy in patients with HIV: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261–269.
Spire, B., Duran, S., Souville, M., Leport, C., Raffi, F., Moatti, J.-P., and the APROCO cohort study group. (2002). Adherence to HAART in HIV-infected patients. Social Sciences and Medicine, 54, 1481–1496.
Stewart, M. A. (1995). Effective physician–patient communication and health outcomes: A review. Canadian Medical Association Journal, 152, 1423–1433.
Stewart, M. A., McWhinney, I., and Buck, C. W. (1979). The doctor–patient relationship and its effect upon outcome. Journal of Royal College of General Practitioners, 29, 77–82.
The Measurement Group. (1997). Module P1: Adherence to Therapy Interview. Retrieved from http://www.themeasurementgroup.com/resource/protease_int.htm.
World Health Organization (WHO). (1998). The WHO CIDI-SF, v1.0, November 1998. Retrieved from http://www.who.int/msa/cidi/cidisf.htm
Wutoh, A. K., Brown, C. M., Kumoji, E. K., Daftary, M. S., Jones, T., Barnes, N. A., and Powell, N. J. (2001). Antiretroviral adherence and use of alternative therapies among older HIV-infected adults. Journal of the National Medical Association, 93, 243–250.
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Ingersoll, K.S., Heckman, C.J. Patient–Clinician Relationships and Treatment System Effects on HIV Medication Adherence. AIDS Behav 9, 89–101 (2005). https://doi.org/10.1007/s10461-005-1684-1
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DOI: https://doi.org/10.1007/s10461-005-1684-1