Adherence communication: a qualitative analysis of physician-patient dialogue

Objective: To explore how HIV/AIDS care physicians communicate with HIV-pos itive patients about the need for adherence to antiretroviral treatment reg imens. Design: Semi-structured, face-to-face interviews, a qualitative research me thod. Setting: A comprehensive, multidisciplinary, HIV/AIDS practice at San Franc isco General Hospital. Participants: Fifteen physicians, most of whom (73%) were board certified i n internal medicine and/or infectious diseases; all were involved in HIV co ntinuity care. Results: Most physicians engaged in both pre- and post-prescription phases of adherence communication with their patients. During the pre-prescription phase, physicians made decisions about offering prescriptions to patients, often based on their beliefs about the patient's likelihood of adhering to therapy. During the post-prescription phase, physicians asked patients que stions about if/how they were adhering to the regimens. Physicians' practic es, such as the length of time spent in the pre-prescription phase, the tim ing of the 'check-ins' in the post-prescription phase, and the overall cont ent of both phases, varied significantly. Conclusions: Physicians have diverse ways of communicating with patients re garding adherence to antiretroviral medications. The effect of such communi cation on treatment outcomes needs to be assessed; however, the potential b enefit suggests that training programs should be developed to improve physi cians' skills in this area. Further studies should be done to assess how ge nerally applicable these findings are to other groups of physicians. (C) 19 99 Lippincott Williams & Wilkins.