Beach Mary Catherine, Roter Debra L, Saha Somnath, Korthuis P Todd, Eggly Susan, Cohn Jonathan, Sharp Victoria, Moore Richard D, Wilson Ira B
Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Welch Center for Prevention, Epidemiology and Clinical Research, USA.
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
Patient Educ Couns. 2015 Sep;98(9):1078-83. doi: 10.1016/j.pec.2015.05.011. Epub 2015 May 21.
Medication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence.
We randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the roter interaction analysis system (RIAS).
There was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p=.004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p=0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p=0.039), emotional talk (26 vs. 18 statements, p<0.001), and probing of patient opinion (3 vs. 2 statements, p=0.009).
A brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence.
服药依从性在艾滋病护理中至关重要，但医护人员关于依从性的沟通往往不尽人意。我们开展这项研究旨在改善医患之间关于艾滋病药物依从性的沟通。
我们将三个艾滋病护理点的26名医护人员随机分为两组，一组接受基于动机性访谈原则应用于药物依从性的一小时沟通技巧培训，另一组不接受培训。在常规门诊就诊前，接受培训的医护人员的不依从患者会得到指导，以便与他们的医护人员讨论依从性问题。未接受培训的医护人员的患者则未得到指导。我们使用罗特互动分析系统（RIAS）对医患互动进行录音和编码。
在与干预组患者及医护人员的就诊过程中，关于治疗方案的对话更多（分别为167次和128次，p = 0.004），其中大部分陈述来自医护人员。这些就诊还包括更多针对不依从问题的头脑风暴解决方案（41%对22%，p = 0.026）。与对照组就诊医护人员相比，干预组医护人员进行了更多积极的交谈（44次对38次陈述，p = 0.039）、情感交谈（26次对18次陈述，p < 0.001）以及对患者意见的探究（3次对2次陈述，p = 0.009）。
简短的医护人员培训结合患者指导课程，改善了医护人员的沟通行为，并增加了关于药物依从性的对话。
