Patient Empowerment Impacts Medication Adherence among
HIV-Positive Patients in the Veteran’s Health Administration
Tan Pham1,2,3, Kristin Mattocks1,2, Jane Ungemack3, Marysol Asencio3, Amy Justice1,2
(1) VA Connecticut Health Care System; (2) Yale University School of Medicine; (3) University of Connecticut
Background
Objectives
Over the last 30 years, there has been an increasing trend
in patient empowerment where patients are ‘taking charge’
of their own disease management and their interaction
with medical providers. Patients who are empowered are
active knowledge seekers and/or are involved in their
treatment decision-making. These empowered behaviors
have been shown to have positive health outcomes in
other chronic diseases. For HIV-positive patients, a
positive health outcome can be achieved through HIV
mediation adherence at least 80%. Little research has
been conducted on patient empowerment and medication
adherence among HIV-infected patients.
•To examine the relationship between patient empowerment and highly
active antiretroviral (HAART) medication adherence
Table 1: HIV Positive Patient Characteristics
To assess active knowledge seeking, the following two 4-point statements
were combined: “I want to take an active role in the medical management of
my HIV infection and its complications” and “I want to know as much as I can
about the medical aspects of my HIV condition and treatment.” Cronbach’s α
for the scale was .68.
Demographic
Age [mean]
Race/Ethnicity
Hispanic
Caucasian
African American
Gender
Female
Male
Education
<High School
High School/GED
Some College
College Graduate
Graduate School
Income
<$6,000
$6,000-$11,999
$12,000-$24,999
$25,000-$49,999
$50,000+
Medication Adherence [mean]
Percentage
(n=3272)
49
10%
20%
70%
3%
97%
7%
34%
44%
10%
5%
20%
31%
25%
18%
7%
80%
Methods
Method: This study is a cross-sectional analysis study using the first survey
from the patient’s first entry into the Veterans Aging Cohort Study (VACS).
VACS is a longitudinal, prospective multisite observational study of HIV
infected and uninfected patients seen in Veteran’s Health Administration
infectious disease and general clinics. Medication Adherence was calculated
using Steiner’s general method of compliance assessment using patient’s
pharmacy records
To assess decision-making involvement, the following two 4 point statements
were combined: “It is better to trust a doctor or nurse in charge of a medical
procedure than to question what they are doing” and “I’d rather have doctors
and nurses make decisions about what’s best than for them to give me a lot of
choices.” These two statements were combined into a four-point scale where
a higher score would indicate strong desire for decision-making involvement
(empowerment). Cronbach’s α for the scale was .78.
Social support is measured by how often the patient sees their relatives and
how often the patient sees their close friends. Both questions were combined
into a five-point scale. Cronbach’s α for the scale was .60.
Analysis: Univariate statistics were used to describe the patient
characteristics. A multiple logistic regression model was used to determine the
impact of patient empowerment on medication adherence while adjusting for
patient characteristics. Medication Adherence is defined as pharmacy refilled
greater than 80%.
Discussion
Patients who are more empowered (active knowledge seeking and decisionmaking involvement) are more likely to be adherent to their medication.
Consistent with the literature on medication adherence on other chronic
diseases, age and education are positively associated with medication
adherence.
Additional research is needed focusing on patient empowerment, HIV
medication adherence and comorbidities to better understand this relationship.
Results
Table 2: Odds of Medication Adherence by Patient
Empowerment, Patient Demographics, Substance and
Mental Health Characteristics among HIV-positive
patients
Variable
Adjusted
95% CI
Odds Ratio
Patient Empowerment
Active Knowledge Seeking
1.118
(1.020,1.374)
Decision-Making Involvement 1.061
(1.012,1.175)
Age
1.023
(1.012,1.034)
Race and Ethnicity
Caucasian
Reference ----African American
0.535
(0.430,0.666)
Hispanic
0.552
(0.390,0.780)
Gender
Male
Reference ----Female
0.874
(0.480,1.588)
Education
1.073
(1.003,1.145)
Income
1.003
(0.924,1.089)
Patient Satisfaction
1.097
(1.058,1.166)
Social Support
0.966
(0.894,1.044)
Disease Severity
Viral Load
1.000
(1.000,1.000)
CD4 Count
1.001
(1.000,1.001)
Mental Health
Major Depression
1.033
(0.758,1.408)
Minor Depression
1.004
(0.757,1.331)
PTSD
1.245
(0.851,1.823)
Bipolar Disorder
0.891
(0.552,1.440)
Anxiety
0.800
(0.524,1.222)
Substance Abuse
Drug Abuse
1.038
(0.786,1.370)
Alcohol Abuse
0.930
(0.672,1.286)
Acknowledgements
This research project was conducted as apart of Tan Pham’s Master of
Public Health thesis at the University of Connecticut. This research
data was made available by Dr. Amy Justice’s Veterans Aging Cohort
Study.