Abstract
Disparities in HIV care and outcomes negatively affect Black and Hispanic patients. Features of clinical communication may be a factor. This study is based on coding transcripts of 404 routine outpatient visits by people with HIV at four sites, using a validated system. In models adjusting for site and patient characteristics, with provider as a random effect, providers were more “verbally dominant” with Black patients than with others. There was more discussion about ARV adherence with both Black and Hispanic patients, but no more discussion about strategies to improve adherence. Providers made more directive utterances discussing ARV treatment with Hispanic patients. Possible interpretations of these findings are that providers are less confident in Black and Hispanic patients to be adherent; that they place too much confidence in their White, non-Hispanic patients; or that patients differentially want such discussion. The lack of specific problem solving and high provider directiveness suggests areas for improvement.
Similar content being viewed by others
References
Moore RD, Stanton D, Gopalan R, Chaisson RE. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med. 1994;330(11):763–8.
Andersen R, Bozzette S, Shapiro M, St Clair P, Morton S, Crystal S, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS consortium. HIV cost and services utilization study. Health Serv Res. 2000;35(2):389–416.
Asch SM, Gifford AL, Bozzette SA, Turner B, Mathews WC, Kuromiya K, et al. Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. J Acquir Immune Defic Syndr. 2001;28(4):340–4.
Shapiro MF, Morton SC, McCaffrey DF, Senterfitt JW, Fleishman JA, Perlman JF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and services utilization study. JAMA. 1999;281(24):2305–15.
King WD, Minor P, Ramirez Kitchen C, Ore LE, Shoptaw S, Victorianne GD, et al. Racial, gender and geographic disparities of antiretroviral treatment among US medicaid enrolees in 1998. J Epidemiol Community Health. 2008;62(9):798–803.
Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS Behav. 2009;13(3):582–602.
Woldemichael G, Christiansen D, Thomas S, Benbow N. Demographic characteristics and survival with AIDS: health disparities in Chicago, 1993–2001. Am J Public Health. 2009;99(Suppl 1):S118–23.
Hicks PL, Mulvey KP, Chander G, Fleishman JA, Josephs JS, Korthuis PT, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2007;19(9):1134–40.
Oh DL, Sarafian F, Silvestre A, Brown T, Jacobson L, Badri S, et al. Evaluation of adherence and factors affecting adherence to combination antiretroviral therapy among White, Hispanic, and Black men in the MACS Cohort. J Acquir Immune Defic Syndr. 2009;52(2):290–3.
Kyser M, Buchacz K, Bush TJ, Conley LJ, Hammer J, Henry K, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011;23(5):601–11.
Sullivan PS, Campsmith ML, Nakamura GV, Begley EB, Schulden J, Nakashima AK. Patient and regimen characteristics associated with self-reported non-adherence to antiretroviral therapy. PLoS One. 2007;2(6):e552.
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.
Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32(2):175–81.
Roter DL. The roter method of interaction process analysis. RIAS Manual: Johns Hopkins University; 1991.
Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Wilson I, et al. Differences in patient–provider communication for Hispanic compared to non-Hispanic White patients in HIV care. J Gen Intern Med. 2010;25(7):682–7.
Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Wilson IB, et al. Patient–provider communication differs for black compared to White HIV-infected patients. AIDS Behav. 2011;15(4):805–11.
Laws MB, Beach MC, Lee Y, Rogers WH, Saha S, Korthuis PT, et al. Provider–patient adherence dialogue in HIV care: results of a multisite study. AIDS Behav. 2013;17(1):148–59.
Beck RS, Daughtridge R, Sloane PD. Physician–patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15(1):25–38.
Fine E, Reid MC, Shengelia R, Adelman RD. Directly observed patient–physician discussions in palliative and end-of-life care: a systematic review of the literature. J Palliat Med. 2010;13(5):595–603.
Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423–33.
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 Suppl):S110–27.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Int Med. 1988;3(5):448–57.
Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor–patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18.
Searle JR. Speech acts. An essay in the philosophy of language. Cambridge: Cambridge University Press; 1969.
Austin JL. How to do things with words. Oxford: Oxford University Press; 1962.
Habermas J. The theory of communicative action. V.1. Reason and the rationalization of society. V.2. Lifeworld and system: a critique of functionalist reason. Boston: Beacon Press; 1984.
Roter DL. Roter interaction analysis manual. Baltimore: RIAS; 2008.
Ford S, Hall A, Ratcliffe D, Fallowfield L. The medical interaction process system (MIPS): an instrument for analysing interviews of oncologists and patients with cancer. Soc Sci Med. 2000;50(4):553–66.
Wilson IB, Laws MB, Safren SA, Lee Y, Lu M, Coady W, et al. Provider focused intervention increases HIV antiretroviral adherence related dialogue, but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr Human Retrovirol. 2010;53(3):338–47.
Laws MB, Bradshaw YS, Safren SA, Beach MC, Lee Y, Rogers W, et al. Discussion of sexual risk behavior in HIV care is infrequent and appears ineffectual: a mixed methods study. AIDS Behav. 2011;15(4):812–22.
Laws MB, Epstein L, Lee Y, Rogers W, Beach MC, Wilson I. Visit length and constructs of patient-centeredness in HIV care. Patient Educ Couns. 2011;85(3):e183–8.
Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215–21.
Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.
Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.
Cene CW, Roter D, Carson KA, Miller ER III, Cooper LA. The effect of patient race and blood pressure control on patient–physician communication. J Gen Intern Med. 2009;24(9):1057–64.
Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, D.C: The National Academies Press; 2003.
Balsa AI, McGuire TG. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ. 2003;22(1):89–116.
Gifford AL, Bormann JE, Shively MJ, Wright BC, Richman DD, Bozzette SA. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr. 2000;23(5):386–95.
Golin CE, Wenger NS, Liu H, Dawson NV, Teno JM, Desbiens NA, et al. A prospective study of patient–physician communication about resuscitation. J Am Geriatr Soc. 2000;48(5 Suppl):S52–60.
Valenzuela JM, La Greca AM, Hsin O, Taylor C, Delamater AM. Prescribed regimen intensity in diverse youth with type 1 diabetes: role of family and provider perceptions. Pediatr Diabetes. 2011;12(8):696–703.
Acknowledgments
This research was supported by award numbers R34MH089279 and R01MH083595 from the National Institute of Mental Health; and by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). Dr. Wilson was supported by the National Institute of Mental Health (2 K24MH092242). Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). Dr. Saha was supported by the Department of Veterans Affairs. The views expressed here are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the Department of Veterans Affairs is intended or should be inferred.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Laws, M.B., Lee, Y., Rogers, W.H. et al. Provider–Patient Communication About Adherence to Anti-retroviral Regimens Differs by Patient Race and Ethnicity. AIDS Behav 18, 1279–1287 (2014). https://doi.org/10.1007/s10461-014-0697-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-014-0697-z