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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1055 — Development and Testing of an HIV Medication Touch-Screen Patient Adherence Tool with Telephone-Based, Targeted Adherence Counseling

McInnes DK (VA New England Healthcare System; HIV/Hepatitis QUERI), Hardy H (HIV Pharmacotherapy Program, Boston Medical Center), Goetz MB (VA Greater Los Angeles Healthcare System; HIV/Hepatitis QUERI), Skolnik PR (Center for HIV/AIDS Care and Research, Boston Medical Center and Boston University School of Medicine), Brewster AL (Boston University School of Public Health), Hofmann RH (West Portal Software Corporation), Gifford AL (VA New England Healthcare System; HIV/Hepatitis QUERI)

Objectives:
Non-adherence to medications is a serious problem for Veterans with HIV. Improving adherence requires identifying less adherent patients and providing appropriate services/support. We designed and pilot-tested an intervention using a clinical computer assisted self-interview (CASI) to help identify non-adherent patients, and to provide telephone adherence support.

Methods:
Formative evaluation of the intervention included pilot field testing of the CASI with HIV+ Veterans at an urban VA. Using a touch-screen tablet personal computer, patients answered questions in the clinical waiting area prior to seeing their HIV doctor. Questions assessed patient knowledge of their medications, medication errors, self-reported adherence, and adherence barriers. A real-time report summarized patient responses for the provider. After formative testing the intervention was augmented by telephone behavioral counseling support sessions with an adherence care manager (ACM). Evaluation included CASI data analysis, questionnaires, and provider exit interviews.

Results:
Formative testing of the prototype CASI involved 72 HIV+ Veterans and 11 providers at an urban VA Medical Center. All successfully completed the CASI, with 77% reporting it was very easy to use and 21% indicating somewhat easy. Using the accepted HIV medication cutoff (95% of doses), 37% of Veterans reported non-adherence over the previous 3 days, and 53% reported 30-day non-adherence. Importantly, for 22% of cases, providers incorrectly judged patients as adherent, when in fact patients reported non-adherence. Consequently the HIV CASI system was further rolled out in two other VA HIV clinics and one urban safety-net hospital.

Implications:
A CASI-based adherence intervention helped identify non-adherence and medication taking errors, and demonstrated that providers often assess patient adherence poorly. The intervention was enhanced after the formative study, adding the ACM to improve systems for adherence support. The redesigned intervention has 3 reinforcing elements: a) improved assessment of patient adherence; b) reduced time demands on HIV care providers for conducting detailed adherence questioning; and c) access to specialized adherence counseling for non-adherent Veterans.

Impacts:
CASI assessment and phone-based adherence counseling can be implemented in routine VA HIV care. This strategy may be useful for HIV+ Veterans and for others with chronic disease that requires long-term medication adherence.


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