How Well Do Clinicians Estimate Patients' Adherence to Combination Antiretroviral Therapy?

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2002 Mar 21

PMID 11903770

Citations 56

Authors

Loren G Miller

Honghu Liu

Ron D Hays

Carol E Golin

C Keith Beck

Steven M Asch

Yingying Ma

Andrew H Kaplan

Neil S Wenger

Affiliations

Soon will be listed here.

Abstract

Objective: Adherence to combination antiretroviral therapy is critical for clinical and virologic success in HIV-infected patients. To combat poor adherence, clinicians must identify nonadherent patients so they can implement interventions. However, little is known about the accuracy of these assessments. We sought to describe the accuracy of clinicians' estimates of patients' adherence to combination antiretroviral therapy.

Setting: Public HIV clinic.

Design: Prospective cohort study. During visits, we asked clinicians (nurse practitioners, residents and fellows, and their supervising attending physicians) to estimate the percentage of antiretroviral medication taken by patients over the last 4 weeks and predicted adherence over the next 4 weeks. Adherence was measured using electronic monitoring devices, pill counts, and self-reports, which were combined into a composite adherence measure.

Patients And Participants: Clinicians estimated 464 episodes of adherence in 82 patients.

Results: Among the 464 adherence estimates, 264 (57%) were made by principal care providers (31% by nurse practitioners, 15% by fellows, 6% by residents, and 5% by staff physicians) and 200 (43%) by supervising attending physicians. Clinicians' overestimated measured adherence by 8.9% on average (86.2% vs 77.3%). Greater clinician inaccuracy in adherence prediction was independently associated with higher CD4 count nadir (1.8% greater inaccuracy for every 100 CD4 cells, P=.005), younger patient age (3.7% greater inaccuracy for each decade of age, P=.02), and visit number (P=.02). Sensitivity of detecting nonadherent patients was poor (24% to 62%, depending on nonadherence cutoff). The positive predictive value of identifying a patient as nonadherent was 76% to 83%.

Conclusions: Clinicians tend to overestimate medication adherence, inadequately detect poor adherence, and may therefore miss important opportunities to intervene to improve antiretroviral adherence.

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References

CARPENTER C, Cooper D, Fischl M, Gatell J, Gazzard B, Hammer S . Antiretroviral therapy in adults: updated recommendations of the International AIDS Society-USA Panel. JAMA. 2000; 283(3):381-90. DOI: 10.1001/jama.283.3.381. View

Valdez H, Lederman M, Woolley I, Walker C, Vernon L, Hise A . Human immunodeficiency virus 1 protease inhibitors in clinical practice: predictors of virological outcome. Arch Intern Med. 1999; 159(15):1771-6. DOI: 10.1001/archinte.159.15.1771. View

Tuldra A, Fumaz C, Ferrer M, Bayes R, Arno A, Balague M . Prospective randomized two-Arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2000; 25(3):221-8. DOI: 10.1097/00126334-200011010-00003. View

Liu H, Golin C, Miller L, Hays R, Beck C, Sanandaji S . A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001; 134(10):968-77. DOI: 10.7326/0003-4819-134-10-200105150-00011. View

Sontag D, Richardson L . Doctors withhold H.I.V. pill regimen from some. N Y Times Web. 1997; :1, 35. View

Davis M . Variations in patients' compliance with doctors' orders: analysis of congruence between survey responses and results of empirical investigations. J Med Educ. 1966; 41(11):1037-48. View

Caron H, Roth H . Patients' cooperation with a medical regimen. Difficulties in identifying the noncooperator. JAMA. 1968; 203(11):922-6. View

Moulding T, Onstad G, Sbarbaro J . Supervision of outpatient drug therapy with the medication monitor. Ann Intern Med. 1970; 73(4):559-64. DOI: 10.7326/0003-4819-73-4-559. View

Roth H, Caron H, Hsi B . Estimating a patient's cooperation with his regimen. Am J Med Sci. 1971; 262(5):269-73. DOI: 10.1097/00000441-197111000-00004. View

10.

Mushlin A, Appel F . Diagnosing potential noncompliance. Physicians' ability in a behavioral dimension of medical care. Arch Intern Med. 1977; 137(3):318-321. DOI: 10.1001/archinte.137.3.318. View

11.

Norell S . Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Soc Sci Med E. 1981; 15(1):57-61. DOI: 10.1016/0271-5384(81)90063-6. View

12.

Gilbert J, Evans C, Haynes R, Tugwell P . Predicting compliance with a regimen of digoxin therapy in family practice. Can Med Assoc J. 1980; 123(2):119-22. PMC: 1704655. View

13.

Kass M, Gordon M, Meltzer D . Can ophthalmologists correctly identify patients defaulting from pilocarpine therapy?. Am J Ophthalmol. 1986; 101(5):524-30. DOI: 10.1016/0002-9394(86)90940-2. View

14.

Zeger S, Liang K, Albert P . Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988; 44(4):1049-60. View

15.

Cramer J, Mattson R, Prevey M, Scheyer R, Ouellette V . How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989; 261(22):3273-7. View

16.

Charney E, Bynum R, Eldredge D, Frank D, MACWHINNEY J, McNABB N . How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics. 1967; 40(2):188-95. View

17.

Samet J, Libman H, Steger K, Dhawan R, Chen J, Shevitz A . Compliance with zidovudine therapy in patients infected with human immunodeficiency virus, type 1: a cross-sectional study in a municipal hospital clinic. Am J Med. 1992; 92(5):495-502. DOI: 10.1016/0002-9343(92)90746-x. View

18.

Dunbar-Jacob J . Contributions to patient adherence: is it time to share the blame?. Health Psychol. 1993; 12(2):91-2. DOI: 10.1037/0278-6133.12.2.91. View

19.

Broers B, Morabia A, Hirschel B . A cohort study of drug users' compliance with zidovudine treatment. Arch Intern Med. 1994; 154(10):1121-7. View

20.

Mason B, Matsuyama J, Jue S . Assessment of sulfonylurea adherence and metabolic control. Diabetes Educ. 1995; 21(1):52-7. DOI: 10.1177/014572179502100109. View