Received from the Department of Medicine (CEG), University of North Carolina at Chapel Hill; the Cecil G. Sheps Center for Health Services Research (CEG, SRS); the Department of Health Behavior and Health Education (CEG), University of North Carolina School of Public Health; and the Division of Pharmaceutical Policy and Evaluative Sciences (SRS), University of North Carolina School of Pharmacy, Chapel Hill, NC; and UNC Center for AIDS Research (SRS, CEG); and Duke University Center for Health Policy, Law and Management (SR), Durham, NC.
Adherence Counseling Practices of Generalist and Specialist Physicians Caring for People Living with HIV/AIDS in North Carolina
Article first published online: 28 JAN 2004
Journal of General Internal Medicine
Volume 19, Issue 1, pages 16–27, January 2004
How to Cite
Golin, C. E., Smith, S. R. and Reif, S. (2004), Adherence Counseling Practices of Generalist and Specialist Physicians Caring for People Living with HIV/AIDS in North Carolina. Journal of General Internal Medicine, 19: 16–27. doi: 10.1111/j.1525-1497.2004.21151.x
- Issue published online: 28 JAN 2004
- Article first published online: 28 JAN 2004
- medication compliance;
CONTEXT: National guidelines recommend that practitioners assess and reinforce patient adherence when prescribing antiretroviral (ART) medications, but the extent to which physicians do this routinely is unknown.
OBJECTIVE: To assess the adherence counseling practices of physicians caring for patients with HIV/AIDS in North Carolina and to determine characteristics associated with providing routine adherence counseling.
DESIGN: A statewide self-administered survey.
SETTING AND PARTICIPANTS: All physicians in North Carolina who prescribed a protease inhibitor (PI) during 1999. Among the 589 surveys sent, 369 were returned for a response rate of 63%. The 190 respondents who reported prescribing a PI in the last year comprised the study sample.
MAIN OUTCOME MEASURES: Physicians reported how often they carried out each of 16 adherence counseling behaviors as well as demographics, practice characteristics, and attitudes.
RESULTS: On average, physicians reported spending 13 minutes counseling patients when starting a new 3-drug ART regimen. The vast majority performed basic but not more extensive adherence counseling; half reported carrying out 7 or fewer of 16 adherence counseling behaviors “most” or “all of the time.” Physicians who reported conducting more adherence counseling were more likely to be infectious disease specialists, care for more HIV-positive patients, have more time allocated for an HIV visit, and to perceive that they had enough time, reimbursement, skill, and office space to counsel. After also controlling for the amount of reimbursement and availability of space for counseling, physicians who were significantly more likely to perform a greater number of adherence counseling practices were those who 1) cared for a greater number of HIV/AIDS patients; 2) had more time allocated for an HIV physical; 3) felt more adequately skilled; and 4) had more positive attitudes toward ART.
CONCLUSIONS: This first investigation of adherence counseling practices in HIV/AIDS suggests that physicians caring for patients with HIV/AIDS need more training and time allocated to provide antiretroviral adherence counseling services.