Callon Wynne, Saha Somnath, Korthuis P Todd, Wilson Ira B, Moore Richard D, Cohn Jonathan, Beach Mary Catherine
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Portland VA Medical Center, Portland, OR, USA.
AIDS Behav. 2016 May;20(5):1108-15. doi: 10.1007/s10461-015-1231-7.
This study evaluated how clinicians assess antiretroviral (ARV) adherence in clinical encounters, and which questions elicit accurate responses. We conducted conversation analysis of audio-recorded encounters between 34 providers and 58 patients reporting ARV non-adherence in post-encounter interviews. Among 42 visits where adherence status was unknown by providers, 4 providers did not discuss ARVs (10 %), 6 discussed ARVs but did not elicit non-adherence disclosure (14 %), and 32 discussed ARVs which prompted disclosure (76 %). Questions were classified as: (1) clarification of medication ("Are you still taking the Combivir?"); (2) broad ("How's it going with your meds?"); (3) positively-framed ("Are you taking your medications regularly?"); (4) negatively-framed ("Have you missed any doses?"). Clinicians asked 75 ARV-related questions: 23 clarification, 12 broad, 17 positively-framed, and 23 negatively-framed. Negatively-framed questions were 3.8 times more likely to elicit accurate disclosure than all other question types (p < 0.0001). Providers can improve disclosure probability by asking directly about missed doses.
本研究评估了临床医生在临床诊疗过程中如何评估抗逆转录病毒（ARV）治疗的依从性，以及哪些问题能引出准确的回答。我们对34名医护人员与58名在诊后访谈中报告ARV治疗不依从的患者之间的录音诊疗进行了会话分析。在42次医护人员不清楚依从状况的就诊中，4名医护人员未讨论ARV治疗（10%），6名讨论了ARV治疗但未引出不依从情况的披露（14%），32名讨论了ARV治疗并促使患者披露了不依从情况（76%）。问题分为以下几类：（1）药物使用情况澄清（“你还在服用复方新诺明吗？”）；（2）宽泛问题（“你的药物治疗进展如何？”）；（3）正向提问（“你是否按时服药？”）；（4）负向提问（“你有漏服过药物吗？”）。临床医生共提出了75个与ARV治疗相关的问题：23个为药物使用情况澄清问题，12个为宽泛问题，17个为正向提问，23个为负向提问。负向提问引出准确披露的可能性是所有其他问题类型的3.8倍（p < 0.0001）。医护人员可通过直接询问漏服药物情况来提高披露的可能性。
