Patient-reported and physician-estimated adherence to HAART: Social and clinic center-related factors are associated with discordance

Rita Murri, Adriana Ammassari, Maria Paola Trotta, Andrea De Luca, Sara Melzi, Cristina Minardi, Mauro Zaccarelli, Patrizia Rellecati, Paola Santopadre, Fabrizio Soscia, Antonio Scasso, Valerio Tozzi, Maria Ciardi, Gian Carlo Orofino, Pasquale Noto, Antonella D Arminio Monforte, Andrea Antinori, Albert W. Wu

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1104-1110
Number of pages7
JournalJournal of General Internal Medicine
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 2004

Keywords

  • AIDS/HIV
  • Compliance
  • Doctor-patient relationship
  • Health care service
  • Quality of care

ASJC Scopus subject areas

  • Internal Medicine

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    Murri, R., Ammassari, A., Trotta, M. P., De Luca, A., Melzi, S., Minardi, C., Zaccarelli, M., Rellecati, P., Santopadre, P., Soscia, F., Scasso, A., Tozzi, V., Ciardi, M., Orofino, G. C., Noto, P., Monforte, A. D. A., Antinori, A., & Wu, A. W. (2004). Patient-reported and physician-estimated adherence to HAART: Social and clinic center-related factors are associated with discordance. Journal of General Internal Medicine, 19(11), 1104-1110. https://doi.org/10.1111/j.1525-1497.2004.30248.x