The impact of depressive symptoms on patient-provider communication in HIV care.
The impact of depressive symptoms on patient-provider communication in HIV care.
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DOI：
10.1080/09540121.2012.752788
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发表时间：
2013
期刊：
影响因子：
1.7
通讯作者：
Beach MC
中科院分区：
文献类型：
--
作者：
Jonassaint CR;Haywood C Jr;Korthuis PT;Cooper LA;Saha S;Sharp V;Cohn J;Moore RD;Beach MC
患有抑郁症的艾滋病毒携带者的医疗依从性和结果更差。患者与提供者沟通不畅可能是导致这些结果的原因之一。这项横断面研究评估了患者抑郁对患者-提供者沟通质量的影响。对四个艾滋病毒护理地点的患者-提供者访问(n=406)进行录音，并使用Roter互动分析系统(RIAS)进行编码。使用广义估计方程的负二项和线性回归测试了由流行病学研究中心抑郁量表(CES-D)测量的抑郁症状与RIAS测量和访问后患者评级的护理质量和提供者报告的对患者的关注之间的关联。患者平均年龄45岁(20-77岁)，主要为男性(n=286，68.5%)，黑人(n=250，60%)，接受抗逆转录病毒药物治疗(n=334，80%)。女性的CES-D抑郁平均得分(12.0)高于男性(10.6；p=0.03)。抑郁得分没有年龄、种族或教育程度的差异。与那些报告没有/轻度抑郁症状的患者相比，报告严重抑郁症状的患者就诊时间更长，说话速度更慢。有严重抑郁症状的患者更多地建立了情感融洽，但社交融洽的建立较少，他们的提供者进行了更多的数据收集/咨询(PS<；0.05)。在访问后的问卷中，提供者报告对报告更多抑郁症状的患者的积极重视程度较低，并对其进行负面评价(p<；0.01)。反过来，报告更多抑郁症状的患者感觉不那么受尊重，也不太可能报告他们的提供者知道他们是一个人，而不是没有/轻度抑郁症状的患者(PS<；0.05)。出现抑郁症状的患者更大的心理社会需求，以及满足这些需求的时间/资源有限，可能部分导致提供者对其抑郁症状患者的负面态度。这些消极的态度最终可能会对患者与提供者的沟通和艾滋病毒护理的质量产生不利影响。
Persons with HIV who develop depression have worse medical adherence and outcomes. Poor patient–provider communication may play a role in these outcomes. This cross-sectional study evaluated the influence of patient depression on the quality of patient–provider communication. Patient–provider visits (n = 406) at four HIV care sites were audio-recorded and coded with the Roter Interaction Analysis System (RIAS). Negative binomial and linear regressions using generalized estimating equations tested the association of depressive symptoms, as measured by the Center for Epidemiology Studies Depression scale (CES-D), with RIAS measures and postvisit patient-rated quality of care and provider-reported regard for his or her patient. The patients, averaged 45 years of age (range = 20–77), were predominately male (n = 286, 68.5%), of black race (n = 250, 60%), and on antiretroviral medications (n = 334, 80%). Women had greater mean CES-D depression scores (12.0) than men (10.6; p = 0.03). There were no age, race, or education differences in depression scores. Visits with patients reporting severe depressive symptoms compared to those reporting none/mild depressive symptoms were longer and speech speed was slower. Patients with severe depressive symptoms did more emotional rapport building but less social rapport building, and their providers did more data gathering/counseling (ps < 0.05). In postvisit questionnaires, providers reported lower levels of positive regard for, and rated more negatively patients reporting more depressive symptoms (p < 0.01). In turn, patients reporting more depressive symptoms felt less respected and were less likely to report that their provider knows them as a person than none/mild depressive symptoms patients (ps < 0.05). Greater psychosocial needs of patients presenting with depressive symptoms and limited time/resources to address these needs may partially contribute to providers’ negative attitudes regarding their patients with depressive symptoms. These negative attitudes may ultimately serve to adversely impact patient–provider communication and quality of HIV care.
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7.2
作者：
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通讯作者：
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