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2006 HSR&D National Meeting Abstract

3082 — Tablet Audio Computer-Assisted Patient Interview to Assess Medication Adherence in Veterans with HIV

Author List:
Gifford AL (VA San Diego Healthcare System, University of California, San Diego)
Looney DJ (VA San Diego Healthcare System, University of California, San Diego)
Sobo EJ (VA San Diego Healthcare System, San Diego State University)
Blevins CA (VA San Diego Healthcare System)
Chen Y (VA San Diego Healthcare System, University of California, San Diego)
Asch SA (VA Greater Los Angeles Healthcare System, University of California, Los Angeles)
Hofmann R (West Portal Software Corporation)

Patient adherence to antiretroviral medications is a major HIV quality of care issue. Though assessment of adherence is a high clinical priority, VA HIV providers have difficulties identifying patients with adherence problems, and addressing adherence issues in clinical care. Touch-tablet audio-computer assisted patient self-interview (aCASI) may reduce self-report bias and save time by collecting data about medication use directly from patients using a non-judgmental user-friendly interface.

HIV/Adhere aCASI was administered to 72 HIV positive adults using antiretrovirals before their visits at the VA San Diego HIV clinic December 2004-April 2005. Patient errors in regimen knowledge, patient adherence self-reports, and other clinical data were assessed. Providers were surveyed to estimate their patients’ adherence post-visit, based on their usual clinical histories. Provider and aCASI adherence were compared using the accepted standard of >= 95% as adherence reference.

Patients were mostly male (98%), white (63%), and immunocompromised (57% with <500 CD4 cells). Mean time for aCASI completion was 9.2 minutes (range 3.2-27.9). aCASI detected medication errors (patient errors in understanding antiretroviral medication, dose, or number of pills) in 36% of patients. Provider adherence judgments differed from those detected by aCASI in 45% (33/72) of cases (30-day adherence) and 39% (28/72) (3-day adherence). “Missed nonadherence” (provider judgment that the patient was adherent when patient reported nonadherence) was found in 22% (16/72) cases for 30-day adherence and 14% (10/72) cases for 3-day adherence. Missed nonadherence was more common for patients >=50 years (OR 3.4 vs <35 years; p<0.05), and in college graduates (OR 9.0 vs high school; p<0.05).

Providers conducting usual clinical histories often failed to identify patients who themselves reported nonadherence to their HIV medications on aCASI computers. Providers may miss nonadherence more often in older, more educated patients.

Use of aCASI in clinic waiting areas may help providers better identify patients who are making ARV medication errors, and who are nonadherent, by saving time, reducing patient and provider biases, and screening for depression and substance use.

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