Interactive “Video Doctor” Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings

, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.We conducted a parallel groups randomized controlled trial (December 2003–September 2006) at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults) completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476) were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a “Video Doctor” via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months) and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months). Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months) than did controls, and had fewer casual sex partners at (−2.3 vs. −1.4, p = 0.461, at 3 months; and −2.7 vs. −0.6, p = 0.042, at 6 months)., including Video Doctor counseling, is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient settings, and holds promise as a public health HIV intervention

Perceived likeability and competence of simulated patients: Influence on physicians' management plans

The goals of this study were to define the psychological and personality characteristics that physicians attribute to their patients and to determine whether these attributions affect treatment decisions. A Physician Attribution Survey was developed to achieve the first goal, and demonstrated that likeability and competence were salient features of the physician-patient relationship. Videotapes were then created demonstrating patients with three different combinations of likeability and competence: likeable-competent (L-C), unlikeable-competent (U-C) and likeable-incompetent (L-I). After being pre-tested with several samples of health professional students, the tapes were shown to 93 primary care physicians. These physicians then completed both a Physician Attribution Survey and a Patient Management Problem describing their proposed treatment. There were significant differences in treatment on five of nine treatment dimensions, depending upon the characteristics of the patient. First, the L-C patient would be encouraged significantly more often to telephone and to return more frequently for follow-up than would the L-I or U-C patient. Second, the staff would educate the likeable patients significantly more often than they would the unlikeable patients. Third, the physician would offer significantly more patient education to incompetent patients than to competent ones. Fourth, the unlikeable patient would receive significantly more interviewing regarding the psychological aspects of care than would the likeable patients. Fifth, the L-C patient would receive augmented medication more frequently than either the U-C patient or the L-I patient. There were no differences in the use of the physical examination, referral to staff, frequency of return or hospitalization based on the personal characteristics of the patient, although some of these variables were significantly affected by the attributed disease. There were no interactions between patient characteristics and disease as determinants of management. These findings have implications for medical education, studies of medical decision-making, and assessments of physicians' quality of care of patients. The methods developed provide a basis for more extensive and detailed studies of the explicit and implicit theories physicians have regarding the relationship between the personality characteristics of their patients and treatment decisions.

Prenatal weight gain: who is counseled?

BackgroundBecause prenatal counseling is associated with adherence to weight gain guidelines, we sought to identify patient-level characteristics associated with the receipt of counseling on weight gain, nutrition, and exercise during prenatal care.MethodsWe performed a secondary data analysis on a cohort of women enrolled in a prenatal counseling intervention study. We controlled for study group assignment (intervention versus usual care) as well as patient characteristics in a multivariable analysis. We performed three separate multivariable analyses for predictors of provider-patient discussions about (1) weight gain, (2) nutrition, and (3) exercise.ResultsThe cohort consisted of 311 predominantly low-income prenatal patients receiving care at several sites in the San Francisco Bay Area. Prepregnancy body mass index, nutrition knowledge, maternal age, parity, and type of insurance were not significantly associated with receipt of counseling about weight gain, nutrition, and exercise. In the multivariable analysis, white women were significantly less likely to be counseled about nutrition than non-white women (p=0.02). Former smokers were more likely to receive counseling about nutrition and exercise than never smokers (p&lt;0.05). More advanced gestational age was associated with a higher rate of counseling on weight gain (p=0.01).ConclusionsDespite having the highest rates of excessive weight gain nationally, white women were the least likely to receive counseling about nutrition during pregnancy. Interventions that prompt clinicians and simplify counseling may improve counseling rates for all patients during prenatal care

The impact of who you know and where you live on opinions about aids and health care

We hypothesized that public attitudes towards AIDS and the safety of health care in the era of HIV would be more positive for people who knew someone with AIDS. We believed, moreover, that living in areas with high AIDS prevalence would result in more favorable attitudes. To test these hypotheses, we conducted telephone interviews with a random sample of 2000 U.S. adults (response RATE = 75%) in summer 1988. Overall 19.5% of respondents said that they knew someone with AIDS or the AIDS virus. Thirteen percent of people who lived in low prevalence areas reported knowing someone with AIDS, compared with 27% of those in areas of high prevalence. Of the total sample, 38% reported knowing someone they believed was at risk. People who knew someone with AIDS were less likely to say they would change physicians or dentists if their provider was HIV infected or was known to be treating people who were infected. Knowing someone with AIDS was also associated with greater tolerance for those with AIDS to continue to work if they were able and with lower perception of risk of transmission in health care settings. Multivariate regression analyses indicated that personal contact was related to more positive attitudes. Counter to our hypothesis, living in a high prevalence area had no independent effect on attitudes. This surprising finding suggests that, after controlling for personal contact with someone with AIDS, where one lives does not influence attitudes. Because bringing people with AIDS into contact with others may have positive outcomes, we suggest implementation of interventions using this strategy.AIDS attitudes health care survey

Increasing discussions of intimate partner violence in prenatal care using Video Doctor plus Provider Cueing: a randomized, controlled trial.

PurposeTo report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women.MethodsFifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1 month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements.Main findingsParticipants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared with participants receiving usual care at baseline (81.8% vs. 16.7%; p &lt; .001) and at the 1-month follow-up (70.0% vs. 23.5%; p = .005). Summing the number of patient-provider discussions across the two visits at baseline and 1 month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%; p &lt; .001) compared with the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up.ConclusionVideo Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse

Increasing discussions of intimate partner violence in prenatal care using Video Doctor plus Provider Cueing: a randomized, controlled trial.

PurposeTo report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women.MethodsFifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1 month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements.Main findingsParticipants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared with participants receiving usual care at baseline (81.8% vs. 16.7%; p &lt; .001) and at the 1-month follow-up (70.0% vs. 23.5%; p = .005). Summing the number of patient-provider discussions across the two visits at baseline and 1 month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%; p &lt; .001) compared with the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up.ConclusionVideo Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse