Marseille 2007
| Abstract #178 - LENGTH OF CLINIC VISIT AFFECTS ADHERENCE TO ANTIRETROVIRAL THERAPY | ||||
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Session: 24.8: Adherence (Parallel) on Monday @ 16.30-18.30 in HC Chaired by Ana Josefina Guell, Rahul Battcharya Authors: Presenting Author: Dr Adriana Ammassari - INMI "L.Spallanzani", Italy |
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| Additional Authors: MD Adriana Ammassari, MD Maria Paola Trotta, MD Patrizia Marconi, MD Rita Murri, MD Antonella d'Arminio Monforte, MD Andrea Antinori, | ||||
| Aim: Patient-physician relationship has an important role in the delivery of medical care, providing a context in which caring and healing can occur. This issue among HIV-infected persons is particularly important considering the seriousness of the disease, the intensity of medical relations, the demand for preventive education, and the need of optimal adherence to complex antiretroviral therapies. Barriers to good patient-physicians relationship include a great amount of factors including structural obstacles, such as time constraints. We aimed this study to investigate health care characteristics and its potential impact on adherence to highly active antiretroviral therapy (HAART) among HIV-infected persons. | ||||
| Method / Issue: This study was carried out within the AdICoNA Study, a nested study of the ICoNA Cohort (Italian Cohort of Nave for Antiretroviral) focused on the issue of HAART adherence. Adherence was assessed by a self-administered anonymous questionnaire that includes also questions regarding satisfaction with health care: information received, physician competence, appropriateness of examinations, patients feeling of participating in decision making, physician empathy, continuity of care, access to care, and duration of visit. Health care characteristics (number of outpatients, hours of care access, average length of visit, physician continuity, availability of a psychologist or of a social worker) were collected from each clinical center through a standardized survey. | ||||
| Results / Comments: Out of 358 patients enrolled in 23 clinical centers, 23.5% reported to have missed at least one dose in the last three days and were considered non-adherent. Among the health care characteristics, only the mean length of clinical visit had a significant impact on adherence: mean time spent in visit was longer for adherent persons (25.04 minutes; SD +10.9) when compared to non-adherent persons (21.91; +8.04) (P=0.007 at Mann-Whitney). Other predictors of non-adherence in univariable analysis were: younger age, self-reported drug abuse, and unemployment. Conversely, subjects reporting satisfaction (a lot/a fair amount versus a little/not at all) about physicians competence and empathic approach were less likely to be non-adherent. On multivariable analysis, a 41% reduced risk of non-adherence was observed for each adjunctive 10 minutes of visit (Adjusted OR 0.59;95%CI 0.39-0.88; P=0.01) after adjusting for variables significant at univariate analysis. Also younger age (2.31;1.28-4.19;P=0.006), intravenous drug use (2.93;95%CI 1.05-8.19; P=0.04), and unemployment (2.55; 1.34-4.84; P=0.004) were associated with non-adherence; while patients reporting satisfaction about physicians competence (0.18; 0.04-0.97; P=0.05) was at lower risk of being non-adherent. When looking at socio-demographic characteristics associated with length of visit, we found at multivariable analysis that female gender was associated with longer duration (OR 1.81 for a >20 minutes visit; 95%CI 1.02-3.23; P=0.05), and patients asking for more information with shorter (OR 0.58 for a >20 minutes visit; 95%CI 0.35-0.96; P=0.03). | ||||
| Discussion: Our results emphasize the importance of patient-physician relationship in the setting of HIV infection and underscore that the length of visit is crucial to achieve good medication adherence. More time should be taken to establish a comfortable and empathic relationship that enables both patients to discuss their problems or questions and physicians to provide exhaustive information about diagnosis, prognosis, and treatment. | ||||
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