Preventive care counseling practices of HIV medical care providers: Relationships between empirically-derived composite measures of performance

Abstract

Background: Preventive care services and risk-reduction counseling are routinely offered to HIV patients during their routine clinic visits. However, assessment of clinicians’ performance on these practices has been difficult because of the use of many single indicators. This study attempts to evaluate the relationships between empirically-derived composite measures of preventive care counseling practices by HIV medical care providers (HMCP) in outpatient clinical care settings. Methods: Data used in this study were obtained from the Centers of Disease Control and Prevention Medical Monitoring Project HMCP’ survey conducted in Houston/Harris County, Texas between June and September of 2009. Six domain-specific composite preventive care counseling indices developed were subjected to descriptive and correlation analyses. Results: All preventive care counseling indices developed produced significant (P ≤ 0.05) Cronbach’s alpha coefficients that ranged from 0.64 to 0.91. The overall prevention counseling index was significantly (P < 0.001) correlated with all the domain specific indices across patient status (r = 0.67-0.89). There were greater correlations between risk-reduction index (RRi) and disease screening index (DSi), mental health, and substance use index (MSi) and social and family support index in established patients (r = 0.55-0.73, P ≤ 0.01) compared to those in newly-diagnosed patients (r = 0.44-0.56, P ≤ 0.05). Although medication and adherence index was significantly associated with RRi (r = 0.50, P < 0.001) and DSi (r = 0.46, P < 0.001) in the sample population, these associations, disappeared (P > 0.05) during by-group analysis based on patient status. Conclusions: Understanding the magnitude, direction, and probability of relationships between the preventive care counseling indices may help with providers’ self-assessment and prioritization of efforts in areas that will produce better health outcomes and prevent transmission of HIV/sexually transmitted diseases.