Department of Health Services Policy and Practice, Brown University, G-S121-7, Providence, RI 02912, USA.
AIDS Behav. 2013 Jan;17(1):148-59. doi: 10.1007/s10461-012-0143-z.
Few studies have analyzed physician-patient adherence dialogue about ARV treatment in detail. We comprehensively describe physician-patient visits in HIV care, focusing on ARV-related dialogue, using a system that assigns each utterance both a topic code and a speech act code. Observational study using audio recordings of routine outpatient visits by people with HIV at specialty clinics. Providers were 34 physicians and 11 non-M.D. practitioners. Of 415 patients, 66% were male, 59% African-American. 78% reported currently taking ARVs. About 10% of utterances concerned ARV treatment. Among those using ARVs, 15% had any adherence problem solving dialogue. ARV problem solving talk included significantly more directives and control parameter utterances by providers than other topics. Providers were verbally dominant, asked five times as many questions as patients, and made 21 times as many directive utterances. Providers asked few open questions, and rarely checked patients' understanding. Physicians respond to the challenges of caring for patients with HIV by adopting a somewhat physician-centered approach which is particularly evident in discussions about ARV adherence.
很少有研究详细分析医患之间关于抗逆转录病毒治疗的依从性对话。我们全面描述了艾滋病毒护理中的医患就诊情况，重点关注与抗逆转录病毒相关的对话，使用一种系统为每个话语分配主题代码和言语行为代码。这是一项观察性研究，使用音频记录了在专门诊所就诊的艾滋病毒感染者的常规门诊就诊情况。提供者包括 34 名医生和 11 名非医学博士从业者。在 415 名患者中，66%为男性，59%为非裔美国人。78%报告目前正在服用抗逆转录病毒药物。大约 10%的话语涉及抗逆转录病毒治疗。在那些使用抗逆转录病毒药物的患者中，有 15%的患者进行了任何解决依从性问题的对话。抗逆转录病毒问题解决对话中，提供者的指令和控制参数话语明显多于其他话题。提供者在语言上占据主导地位，向患者提出的问题是患者的五倍，并发出 21 倍的指令性话语。提供者很少提出开放性问题，也很少检查患者的理解情况。医生通过采用一种以医生为中心的方法来应对照顾艾滋病毒感染者的挑战，这种方法在讨论抗逆转录病毒药物依从性时尤为明显。
