Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients

•We randomized providers to receive or not receive brief communication training.•Patients were coached to discuss medication adherence with their providers.•Intervention providers made more emotional and positive statements to patients.•Intervention providers asked for patient opinion more often.•Intervention providers and patients talked more about therapeutic regimens.

IntroductionMedication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence.MethodsWe randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the roter interaction analysis system (RIAS).ResultsThere was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p = .004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p = 0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p = 0.039), emotional talk (26 vs. 18 statements, p < 0.001), and probing of patient opinion (3 vs. 2 statements, p = 0.009).ConclusionA brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence.