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How well do clinicians estimate patients’ adherence to combination antiretroviral therapy?

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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 fellow, 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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Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Harbor-UCLA Medical Center and Harbor-UCLA Research and Education Institute, 1124 West Carson St., Box 466, 90509, Torrance, CA

    Loren G. Miller MD, MPH

  2. Division of Allergy and Immunology, Harbor-UCLA Medical Center, Torrance, Calif

    C. Keith Beck MD

  3. the Department of Medicine, University of California, Los Angeles

    Honghu Liu PhD, Ron D. Hays PhD, Steven M. Asch MD, MPH, Yingying Ma BS & Neil S. Wenger MD, MPH

  4. the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles

    Steven M. Asch MD, MPH

  5. the UCLA AIDS Institute, Los Angeles, Calif

    Loren G. Miller MD, MPH, Honghu Liu PhD, Ron D. Hays PhD & Neil S. Wenger MD, MPH

  6. Department of Medicine, University of North Carolina, Chapel Hill, NC

    Carol E. Golin MD

  7. Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC

    Andrew H. Kaplan MD

Authors
  1. Loren G. Miller MD, MPH
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  2. Honghu Liu PhD
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  3. Ron D. Hays PhD
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  4. Carol E. Golin MD
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  5. C. Keith Beck MD
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  6. Steven M. Asch MD, MPH
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  7. Yingying Ma BS
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  9. Neil S. Wenger MD, MPH
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Corresponding author

Correspondence to Loren G. Miller MD, MPH.

Additional information

This study was supported in part by grants from the National Institutes of Health (Al41413), the UCLA AIDS Institute (NIH Al28697) and the Department of Veterans Affairs Office of Academic Affiliations, Special Fellowship in Ambulatory Care. Dr. Asch’s time is supported by a Career Development award from the VA Health Services Research and Development Office.

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Miller, L.G., Liu, H., Hays, R.D. et al. How well do clinicians estimate patients’ adherence to combination antiretroviral therapy?. J GEN INTERN MED 17, 1–11 (2002). https://doi.org/10.1046/j.1525-1497.2002.09004.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.09004.x

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