TY - JOUR
T1 - Patient-reported and physician-estimated adherence to HAART
T2 - Social and clinic center-related factors are associated with discordance
AU - Murri, Rita
AU - Ammassari, Adriana
AU - Trotta, Maria Paola
AU - De Luca, Andrea
AU - Melzi, Sara
AU - Minardi, Cristina
AU - Zaccarelli, Mauro
AU - Rellecati, Patrizia
AU - Santopadre, Paola
AU - Soscia, Fabrizio
AU - Scasso, Antonio
AU - Tozzi, Valerio
AU - Ciardi, Maria
AU - Orofino, Gian Carlo
AU - Noto, Pasquale
AU - Monforte, Antonella D.Arminio
AU - Antinori, Andrea
AU - Wu, Albert W.
N1 - Funding Information:
This study was funded by the Istituto Superiore di Sanità— II and III Programma Nazionale di Ricerca sull’AIDS and Ricerca Corrente e Finalizzata degli IRCCS. The I.CO.N.A. network is supported by an educational grant from Glaxo-SmithKline, Italy.
PY - 2004/11
Y1 - 2004/11
N2 - OBJECTIVES: To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy (HAART) and identify factors related to discordance in these two assessments. DESIGN: Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naïve Antiretrovirals (ICONA) study. SETTING: Tertiary clinical centers. PARTICIPANTS: The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated the current HAART adherence of their patient. MAIN OUTCOME MEASURE: Discordance between patient and physician on adherence to antiretroviral therapy. RESULTS: From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of 315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells × 10 6/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference, sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%, 66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance on adherence to antiretrovirals. CONCLUSIONS: Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social variables and factors related to the clinical center were important predictors of discordance between patients and physicians. Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
AB - OBJECTIVES: To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy (HAART) and identify factors related to discordance in these two assessments. DESIGN: Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naïve Antiretrovirals (ICONA) study. SETTING: Tertiary clinical centers. PARTICIPANTS: The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated the current HAART adherence of their patient. MAIN OUTCOME MEASURE: Discordance between patient and physician on adherence to antiretroviral therapy. RESULTS: From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of 315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells × 10 6/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference, sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%, 66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance on adherence to antiretrovirals. CONCLUSIONS: Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social variables and factors related to the clinical center were important predictors of discordance between patients and physicians. Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
KW - AIDS/HIV
KW - Compliance
KW - Doctor-patient relationship
KW - Health care service
KW - Quality of care
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U2 - 10.1111/j.1525-1497.2004.30248.x
DO - 10.1111/j.1525-1497.2004.30248.x
M3 - Article
C2 - 15566439
AN - SCOPUS:9244243090
SN - 0884-8734
VL - 19
SP - 1104
EP - 1110
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 11
ER -