Physicians counsel new patients more effectively

CDC-funded survey highlights problem areas

The Centers for Disease Control and Prevention (CDC) is focusing on the role of physicians in its prevention for positives initiative, but according to one survey funded by the agency, the available prevention counseling is less than optimal.

"What our findings show is that providers are doing prevention counseling more with new patients than with established patients," says Lisa Metsch, PhD, associate professor of epidemiology and public health at the University of Miami School of Medicine. "But the prevention counseling is less than optimal for both."

The study found 60% of physicians reported providing prevention counseling to at least 90% of their HIV patients at the first visit, but only 14% of physicians provided prevention counseling to established patients.1

Also, HIV physicians were less likely to provide prevention counseling to male patients than to female patients, who tend to communicate better with their doctors.1

"Physicians who spent an average of more than 30 minutes with patients were more likely to provide counseling, and those who served more male patients were less likely to counsel," Metsch says. "This is consistent with other literature that has shown that sometimes female patients communicate better with their doctors and they tend to ask more questions than male patients, and women are more comfortable discussing issues of a sexual matter.

"One surprising finding is that infectious disease physicians when compared with other doctors were less likely to provide prevention counseling," she adds. "The reason is all of their other demands and other things that they’re focusing on in the clinic visits.

"This study represents, to our knowledge, the only comprehensive physician study done in four cities," Metsch says. "We looked at different factors and found that those who had more time to spend with patients were more likely to be doing prevention counseling."

Specifically, the study concluded that interventions need to be developed with physicians in mind, and these should include strategies for overcoming barriers to doctors providing counseling to HIV-infected patients.1

"The CDC has recognized that the physician has been an underutilized resource," she notes. "New guidelines released in July of 2003 emphasize the importance of providers being a partner in providing prevention and counseling to their patients, so intervention strategies with physicians should be developed to improve counseling."

The survey acknowledges a variety of obstacles to optimal physician counseling for HIV patients. These include the following:

  • Managing an HIV patient’s medical care is time-consuming and requires considerable scientific expertise and time.1
  • Antiretroviral therapy requires near 100% adherence so providers spend a great deal of time counseling patients about the need to take their medications.1
  • Physicians sometimes believe patients have psychosocial problems that create a barrier to effective prevention counseling messages, and doctors with larger patient populations may have less time to address these issues.1
  • Infectious disease specialists tend to have less time to focus on primary prevention, and they may believe counseling is better handled by other health professionals.1

Metsch also is involved in a CDC-funded study that is looking at developing an intervention for the HIV medical setting. The multicomponent intervention will involve a computerized risk message that physicians will give to patients, and it will be followed up with a visit by a peer counselor, she says.

"The intervention is designed to fit in with the physician’s time slot, and we only ask them to spend five to 10 minutes on this, making it as easy as possible," Metsch explains.

"The patient does a risk assessment on the computer, and with the patient’s permission, the physician receives a very specific and tailored prevention message based on the theories of change and the IMB — information, motivation, and behavioral skills models," she explains.

That intervention research should be completed within the next year or two, Metsch points out.