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How Do Treatment Priorities Differ Between Patients in HIV Care and Their Providers? A Mixed-Methods Study

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Abstract

Evidence suggests priorities differ between patients in HIV care and their providers regarding topics most important to address in care. At five U.S. sites, we asked patients and providers to prioritize 25 potential topic areas to address during routine visits, and invited patients to discuss selection rationale. Patients (n = 206) and providers (n = 17) showed high discordance in rank order priorities (X2 (24, 223) = 71.12; p < 0.0001). Patients ranked social domains such as HIV stigma highly; a higher proportion of providers prioritized substance use domains. HIV stigma was a higher priority for patients in care fewer than 6 years (Fisher’s exact p = 0.0062), nonwhite patients (Fisher’s exact p = 0.0114), and younger patients (Fisher’s exact p = 0.0281). Patients’ priorities differed between men and women (X2 (24, 188) = 52.89; p < 0.0001), white race vs. other races (X2 (24, 206) = 48.32; p = 0.0023), and Latinos vs. non-Latinos (X2 (24, 206) = 48.65; p = 0.0021). Interviews (n = 79) revealed perceived impact of social context on health and health behaviors.

Resumen

Las pruebas sugieren que los pacientes en tratamiento anti-VIH y los proveedores de aquél tienen prioridades distintas sobre qué aspectos más importantes abordar en el tratamiento. En cinco centros estadounidenses, pedimos a pacientes y proveedores que priorizaran 25 posibles aspectos a abordar durante las consultas de rutina, e invitamos a los pacientes a explicar los motivos de sus elecciones. Entre pacientes (n = 206) y proveedores (n = 17) hubo una disparidad alta a la hora de ordenar sus prioridades (X2 (24, 223) = 71.12; p < 0.0001). Los pacientes dieron gran importancia a los aspectos sociales, tales como el estigma asociado al VIH; una mayor proporción de proveedores dio mayor importancia a lo relativo al uso de sustancias. El estigma asociado al VIH fue una prioridad más alta para los pacientes en tratamiento durante menos de 6 años (prueba exacta de Fisher p = 0.006), pacientes de raza no blanca (prueba exacta de Fisher p = 0.0114) y pacientes más jóvenes (prueba exacta de Fisher p = 0.0281). Las prioridades de los pacientes difirieron entre hombres y mujeres (X2 (24, 188) = 52.89; p < 0.0001), raza blanca frente a otras razas (X2 (24, 206) = 48.32; p = 0.0023), y origen latino frente a no latino (X2 (24, 206) = 48.65; p = 0.0021). Las entrevistas (n = 79) realizadas revelaron una percepción del efecto del contexto social sobre la salud y los comportamientos relacionados con la salud.

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References

  1. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.

    CAS  PubMed  Google Scholar 

  2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–9.

    Article  Google Scholar 

  3. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78.

    Article  CAS  Google Scholar 

  4. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.

    Article  CAS  Google Scholar 

  5. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–39.

    Article  Google Scholar 

  6. Wittink MN, Walsh P, Yilmaz S, Mendoza M, Street RL Jr, Chapman BP, et al. Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors? Patient Educ Couns. 2017;101(2):214–20.

    Article  Google Scholar 

  7. Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res. 2014;14:271.

    Article  Google Scholar 

  8. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70(4):351–79.

    Article  Google Scholar 

  9. Fredericksen RJ, Edwards TC, Merlin JS, Gibbons LE, Rao D, Batey DS, et al. Patient and provider priorities for self-reported domains of HIV clinical care. AIDS Care. 2015;27(10):1255–64.

    Article  Google Scholar 

  10. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871–94.

    Article  Google Scholar 

  11. U.S. Department of Health and Human Services FDA. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes. 2006;4:79.

    Article  Google Scholar 

  12. Crane HM, Crane PK, Tufano JT, Ralston JD, Wilson IB, Brown TD, et al. HIV provider documentation and actions following patient reports of at-risk behaviors and conditions when identified by a web-based point-of-care assessment. AIDS Behav. 2017;21(11):3111–21.

    Article  Google Scholar 

  13. Fredericksen RJ, Crane P, Tufano J, Ralston J, Schmidt S, Brown T, et al. Integrating a web-based patient assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012;4(1):47.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Jensen RE, Rothrock NE, DeWitt EM, Spiegel B, Tucker CA, Crane HM, et al. The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care. Med Care. 2015;53(2):153–9.

    Article  Google Scholar 

  15. IAP2 Spectrum of Public Participation: International Association of Public Participation; 2018. https://cdn.ymaws.com/www.iap2.org/resource/resmgr/pillars/Spectrum_8.5x11_Print.pdf. Accessed 3 Dec 2019.

  16. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd ed. Los Angeles: SAGE; 2018. p. 492.

    Google Scholar 

  17. PROMIS. Dynamic tools to measure health outcomes from the patient perspective: PROMIS (Patient Reported Outcomes Measurement Information System); 2011. http://www.nihpromis.org. Accessed 3 Dec 2019.

  18. Hollander MSJ. Testing for agreement between two groups of judges. Biometrika. 1978;65(2):403–11.

    Article  Google Scholar 

  19. Dedoose version 5.0.11 [Internet]. Sociocultural Research Consultants LLC. 2014. http://www.dedoose.com. Accessed 3 Dec 2019.

  20. Campos CJ, Turato ER. Content analysis in studies using the clinical-qualitative method: application and perspectives. Rev Lat Am Enfermagem. 2009;17(2):259–64.

    Article  Google Scholar 

  21. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

    Article  Google Scholar 

  22. Florom-Smith AL, De Santis JP. Exploring the concept of HIV-related stigma. Nurs Forum. 2012;47(3):153–65.

    Article  Google Scholar 

  23. Horberg MA, Hurley LB, Silverberg MJ, Klein DB, Quesenberry CP, Mugavero MJ. Missed office visits and risk of mortality among HIV-infected subjects in a large healthcare system in the United States. AIDS patient care and STDs. 2013;27(8):442–9.

    Article  Google Scholar 

  24. Singh S, Bradley H, Hu X, Skarbinski J, Hall HI, Lansky A, et al. Men living with diagnosed HIV who have sex with men: progress along the continuum of HIV care—United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(38):829–33.

    PubMed  PubMed Central  Google Scholar 

  25. Voigt I, Wrede J, Diederichs-Egidi H, Dierks ML, Junius-Walker U. Priority setting in general practice: health priorities of older patients differ from treatment priorities of their physicians. Croat Med J. 2010;51(6):483–92.

    Article  Google Scholar 

  26. Thomson S, Doody G. Parallel paths? Patient and doctor priorities in psychiatric outpatient consultations. J Ment Health. 2010;19(5):461–9.

    Article  Google Scholar 

  27. Abbo ED, Zhang Q, Zelder M, Huang ES. The increasing number of clinical items addressed during the time of adult primary care visits. J Gen Intern Med. 2008;23(12):2058–65.

    Article  Google Scholar 

  28. Wittink MN, Yilmaz S, Walsh P, Chapman B, Duberstein P. Customized Care: an intervention to improve communication and health outcomes in multimorbidity. Contemp Clin Trials Commun. 2016;4:214–21.

    Article  Google Scholar 

  29. Fredericksen RJ, Tufano J, Ralston J, McReynolds J, Stewart M, Lober WB, et al. Provider perceptions of the value of same-day, electronic patient-reported measures for use in clinical HIV care. AIDS Care. 2016;28(11):1428–33.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank our patients and the Fenway Community Health and UAB Community Advisory Boards for their insights, and we thank the Madison Clinic Patient Advisory Board for guidance in domain selection and development of the measure. This work was funded by the Patient Centered Outcomes Research Institute (PCORI) SC14-1403-14081. Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757; and UAB CFAR Grant P30 AI027767].

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Authors and Affiliations

  1. Department of Medicine, University of Washington, Seattle, USA

    Rob J. Fredericksen, Emma Fitzsimmons, Laura E. Gibbons, Paul K. Crane & Heidi M. Crane

  2. Fenway Community Health, Boston, USA

    Stephanie Loo, Cristina Gutierrez & Kenneth H. Mayer

  3. 1917 Clinic, University of Alabama, Birmingham, USA

    Sarah Dougherty, Will A. Anderson, Sally Shurbaji & Savannah Burleson

  4. Owen Clinic, University of California, San Diego, USA

    Sonia Avendano-Soto

  5. Department of Medicine, University of California, San Francisco, USA

    Katerina Christopoulos & Joanna Poceta

  6. Department of Medicine, University of Alabama, Birmingham, USA

    Michael J. Mugavero

  7. Department of Medicine, University of California, San Diego, USA

    William C. Mathews

  8. UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104-2499, USA

    Rob J. Fredericksen

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  1. Rob J. Fredericksen
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Correspondence to Rob J. Fredericksen.

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Fredericksen, R.J., Fitzsimmons, E., Gibbons, L.E. et al. How Do Treatment Priorities Differ Between Patients in HIV Care and Their Providers? A Mixed-Methods Study. AIDS Behav 24, 1170–1180 (2020). https://doi.org/10.1007/s10461-019-02746-8

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