Which Clinician Questions Elicit Accurate Disclosure of Antiretroviral Non-adherence When Talking to Patients?
Which Clinician Questions Elicit Accurate Disclosure of Antiretroviral Non-adherence When Talking to Patients?
复制标题
与患者交谈时，哪些临床医生问题可以准确披露抗逆转录病毒治疗不依从的情况？
DOI：
10.1007/s10461-015-1231-7
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发表时间：
2016
影响因子：
4.4
通讯作者：
Beach,MaryCatherine
中科院分区：
文献类型：
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作者：
Callon,Wynne;Saha,Somnath;Korthuis,PTodd;Wilson,IraB;Moore,RichardD;Cohn,Jonathan;Beach,MaryCatherine
这项研究评估了临床医生如何评估临床中抗逆转录病毒（ARV）治疗的依从性，以及哪些问题能得到准确的回答。我们对 34 名提供者和 58 名在会后访谈中报告不遵守抗逆转录病毒疗法的患者之间的录音会面进行了对话分析。在提供者未知依从性的 42 次就诊中，4 名提供者没有讨论抗逆转录病毒药物 (10%)，6 名提供者讨论了抗逆转录病毒药物但没有引起非依从性披露 (14%)，32 名提供者讨论了促使披露的抗逆转录病毒药物 (76%)。问题分为：（1）药物说明（“您还在服用康比韦吗？”）； (2) 广泛（“你的药怎么样了？”）； (3) 积极的框架（“你定期服药吗？”）； (4) 消极框架（“你错过了任何剂量吗？”）。临床医生提出了 75 个与 ARV 相关的问题：23 个澄清问题、12 个宽泛问题、17 个积极框架问题和 23 个消极框架问题。负面框架问题引发准确披露的可能性是所有其他问题类型的 3.8 倍 (p< 0.0001)。提供者可以通过直接询问错过的剂量来提高披露概率。
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.