Provider-patient Adherence Dialogue in HIV Care: Results of a Multisite Study

Department of Health Services Policy and Practice, Brown University, G-S121-7, Providence, RI, 02912, USA, .
AIDS and Behavior (Impact Factor: 3.49). 01/2012; 17(1). DOI: 10.1007/s10461-012-0143-z
Source: PubMed


Few studies have analyzed physician-patient adherence dialogue about ARV treatment in detail. We comprehensively describe physician-patient visits in HIV care, focusing on ARV-related dialogue, using a system that assigns each utterance both a topic code and a speech act code. Observational study using audio recordings of routine outpatient visits by people with HIV at specialty clinics. Providers were 34 physicians and 11 non-M.D. practitioners. Of 415 patients, 66% were male, 59% African-American. 78% reported currently taking ARVs. About 10% of utterances concerned ARV treatment. Among those using ARVs, 15% had any adherence problem solving dialogue. ARV problem solving talk included significantly more directives and control parameter utterances by providers than other topics. Providers were verbally dominant, asked five times as many questions as patients, and made 21 times as many directive utterances. Providers asked few open questions, and rarely checked patients' understanding. Physicians respond to the challenges of caring for patients with HIV by adopting a somewhat physician-centered approach which is particularly evident in discussions about ARV adherence.

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    • "General tagsets have attempted to capture multi-functionality through independent dimensions which produce potentially millions of possible annotations , though in practice the number of variations remains in the hundreds (Jurafsky et al., 1998). Situated work has jointly modelled speech act and domain-specific topics (Laws et al., 2012). Additional structure inspired by linguistics, such as adjacency pairs (Schegloff, 2007) or dialogue games (Carlson, 1983), has been used to build discourse relations between turns. "
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