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RRP 07-281 – HSR&D Study

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RRP 07-281
Improving Patient-Provider Communication about Routine HIV Screening
Barbara G. Bokhour PhD
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: October 2007 - March 2008

BACKGROUND/RATIONALE:
With the availability of effective medications, early diagnosis of HIV reduces mortality and treatment costs. In 2006 the Centers for Disease Control and Prevention (CDC) released new recommendations that all patients between the ages of 13 and 64 be offered HIV testing, regardless of risk status. However even among those at high risk, less than 1/3 of veterans have been tested for HIV. Consequently, improving HIV testing in the VA is a leading priority in the QUERI-HIV/Hepatitis strategic plan.
Primary care providers often say that they know little about communicating with patients about the sensitive topics of HIV risk behavior, and HIV testing. Providers need specific strategies for communicating about HIV in primary care settings.

OBJECTIVE(S):
The goal of this project was to develop and implement a patient-centered communication intervention to encourage routine HIV screening in VA primary care. We (1) assessed barriers and facilitators to HIV testing conversations in VA from both patient and provider perspectives (2) conducted a formative evaluation of existing patient and provider educational materials designed by the Center for Disease Control to increase HIV testing; and (3) developed and piloted a brief HIV communication intervention for VA providers.,

METHODS:
At two VA facilities, we conducted focus groups with providers and with patients to assess barriers and facilitators to HIV testing and evaluate CDC designed materials to encourage HIV testing. We conducted qualitative analyses of the focus groups and designed and implemented a brief communication intervention for providers in the form of a single-session training and a brief information card. One month after the intervention, we conducted a brief survey with the providers regarding the use of the communication skills provided.

FINDINGS/RESULTS:
: Both patients and providers stated a desire to make HIV testing part of routine blood work. They advocated viewing HIV like other chronic diseases. Some patients indicated that although testing should be routine, they wanted to be given a choice about whether to be tested. Both groups identified written informed consent guidelines and forms as a substantial barrier to testing. A major barrier for providers was inadequate time in the clinical encounter to address patient concerns about HIV testing. Patients, however, indicated that they did not believe it was necessary to provide extensive discussion about HIV unless results were positive. Based on these findings and incorporating patient-centered communication strategies, we designed a 45-minute communication training intervention and distributed a pocket card with recommended communication strategies - the 6 R's for Routine Testing. These strategies were well-received by the providers.

IMPACT:
The findings from the pilot intervention in this project may lead to broader implementation of a communication skills training for routine HIV testing in VA. This type of intervention is timely as VA providers become more aware of the recent changes in VA policies encouraging routine testing and eliminating written consent for HIV testing. The dissemination of the communication tools designed in this project may increase detection of HIV disease in veterans and lead to improved health outcomes for those infected..

PUBLICATIONS:

Journal Articles

  1. Wilkinson J, Dreyfus D, Bowen D, Bokhour B. Patient and provider views on the use of medical services by women with intellectual disabilities. Journal of Intellectual Disability Research. 2013 Nov 1; 57(11):1058-67.
  2. Bokhour BG, Solomon JL, Knapp H, Asch SM, Gifford AL. Barriers and facilitators to routine HIV testing in VA primary care. Journal of general internal medicine. 2009 Oct 1; 24(10):1109-14.
Conference Presentations

  1. Bokhour BG, Solomon J, Knapp H, McInnes DK, Ching W, Lowe L, McCoy L, Asch SM, Gifford AL. Improving VA Provider Communication about HIV Testing: A Qualitative Approach to Designing a Communication Intervention. Poster session presented at: VA QUERI National Meeting; 2008 Dec 12; Phoenix, AZ.
  2. Bokhour BG, Solomon JS, Knapp H, Ching W, Schlosser J, Asch S, Gifford AL. Barriers and facilitators to routine HIV testing in VA: Patient and provider perspectives. Presented at: Society of General Internal Medicine Annual Meeting; 2008 Apr 9; Pittsburgh, PA.
  3. Bokhour BG, Solomon JL, Knapp, Asch, Gifford AL. Barriers and Facilitators to Routine HIV Testing in VA. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD.


DRA: none
DRE: Prevention
Keywords: Communication -- doctor-patient, HIV/AIDS, Screening
MeSH Terms: none

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