Client/Provider communication and provider office environment: Impacts on hepatitis B, hepatitis C, and HIV risk assessment

BACKGROUND: Prevention, diagnosis, and treatment of viral hepatitis and HIV depend on appropriate risk assessment. In primary care this requires provider knowledge and effective patient/provider communication. Unnecessary morbidity and mortality result from missed or delayed diagnosis.

OBJECTIVES: 1) Identify risk assessment practices in primary care, 2) determine at-risk patients' experience with assessment methods, and 3) elicit suggestions to improve assessment.

METHODS: Primary care providers in the greater Philadelphia area were interviewed about risk assessment practices. When questionnaires or forms were used, copies were requested. The assessment tools were reviewed by 28 at-risk adults in focus group sessions or interviews. We also requested feedback on ways to improve the process.

RESULTS: Providers self-reported that they implement adequate assessment processes, including interviews, structured interviews, and patient intake forms. When relevant sections of the intake forms were presented to subjects, most reported difficulty with terms used, meaning of questions, question sequence, or expected response format. Some subjects completed the forms but later reported answering questions they did not understand. Most subjects noted that they answer risk behavior questions honestly, but some practice “conditional” honesty based on attitudes and behaviors of the office staff and the provider. Suggestions for improvement included verbal review of questions, repeating questions at each visit, and reducing non-medical staff access to patient information.

CONCLUSION: HIV and hepatitis infections will remain undiagnosed if patients and providers don't engage in accurate, honest communication. Identification of office policies and procedures that inhibit communication is the first step to improved patient care.