A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
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A <strong>Guide</strong> <strong>to</strong> <strong>Primary</strong> <strong>Care</strong> <strong>of</strong> <strong>People</strong> <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong><br />
Chapter 2: Approach <strong>to</strong> the Patient<br />
10%. For patients unprepared <strong>to</strong> alter their risk-taking<br />
behavior, a longer-term strategy is required, and a<br />
nonconfrontational approach such as motivational<br />
interviewing is recommended (see Table 2-3).<br />
When working <strong>with</strong> a patient over time <strong>to</strong> support<br />
behavioral change, it is crucial for the provider <strong>to</strong> be<br />
a consistent source <strong>of</strong> support, hope, and optimism.<br />
By acknowledging positive efforts even when initial<br />
attempts <strong>to</strong> modify behavior fail, by continuing <strong>to</strong> <strong>of</strong>fer<br />
encouragement, and by supporting even small progress,<br />
the provider can help bolster a patient’s resolve and<br />
sense <strong>of</strong> control over his or her actions.<br />
Table 2-3. Motivational Interviewing<br />
Basic Steps:<br />
• Seek <strong>to</strong> understand the patient’s experience<br />
through careful and reflective listening.<br />
• Help the patient voice his or her own reasons<br />
for change.<br />
• Recognize and accept resistance <strong>to</strong> change.<br />
• Affirm the patient’s ability <strong>to</strong> control his or her<br />
own actions.<br />
In this patient-centered approach, the provider seeks an<br />
accurate understanding <strong>of</strong> the patient’s unique experience<br />
<strong>with</strong> certain behaviors. The interviewer listens carefully <strong>to</strong><br />
the patient’s thoughts about his or her behavior, moni<strong>to</strong>rs<br />
readiness for change, clarifies what the patient believes <strong>to</strong><br />
be obstacles <strong>to</strong> change, identifies the patient’s own selfmotivational<br />
statements, and selectively reinforces these<br />
expressions <strong>of</strong> desire, intent, and ability <strong>to</strong> change. In this<br />
manner, the provider yields the role <strong>of</strong> “expert” and <strong>of</strong>fers<br />
affirmation and support for the patient’s ability <strong>to</strong> control his<br />
or her own behavior.<br />
Principles <strong>to</strong> Remember:<br />
• For most people, motivation for change must come<br />
from <strong>with</strong>in. Direct persuasion does not <strong>of</strong>ten result<br />
in sustained behavioral change.<br />
• It is the patient’s task <strong>to</strong> articulate resolve and<br />
ambivalence.<br />
• When patients voice resistance <strong>to</strong> change, it is<br />
preferable <strong>to</strong> recognize and accept a lack <strong>of</strong><br />
readiness than <strong>to</strong> press for immediate change.<br />
Timing is important.<br />
• Patients must understand that resolutions <strong>to</strong><br />
change <strong>of</strong>ten slip, and failure should not become a<br />
reason <strong>to</strong> avoid contact <strong>with</strong> the provider.<br />
KEY POINTS<br />
Caring for patients <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong><br />
requires a strong provider-patient<br />
relationship, a multidisciplinary care<br />
team, and frequent <strong>of</strong>fice visits.<br />
Stigma and discrimination must be<br />
addressed through strong confidentiality<br />
protections, emotional support, and<br />
cultural sensitivity.<br />
Patient education about the disease<br />
process, treatment, and community<br />
resources is a vital component <strong>of</strong> care.<br />
The primary care provider plays a key<br />
role in risk assessment and counseling<br />
for all patients <strong>with</strong> <strong>HIV</strong>.<br />
SUGGESTED RESOURCES<br />
Aranda-Naranjo B, Davis R. Psychosocial<br />
and cultural considerations. In: A <strong>Guide</strong><br />
<strong>to</strong> the Clinical <strong>Care</strong> <strong>of</strong> Women <strong>with</strong> <strong>HIV</strong>/<br />
<strong>AIDS</strong>, 1st ed. Washing<strong>to</strong>n: US Department<br />
<strong>of</strong> Health and Human Services, HRSA,<br />
<strong>HIV</strong>/<strong>AIDS</strong> Bureau; 2001. Available at<br />
http://www.hab.hrsa.gov.<br />
Centers for Disease Control and<br />
Prevention. Incorporating <strong>HIV</strong> prevention<br />
in<strong>to</strong> the medical care <strong>of</strong> persons living<br />
<strong>with</strong> <strong>HIV</strong>. MMWR Recommendations and<br />
Reports, (July 18, 2003; 52(RR12);1-24.<br />
Hecht FM, Wilson IB, Wu AW, Cook RL,<br />
Turner BJ. Society <strong>of</strong> General Internal<br />
Medicine <strong>AIDS</strong> Task Force. Optimizing care<br />
for persons <strong>with</strong> <strong>HIV</strong> infection.<br />
Ann Intern Med. 1999;131:136-143.<br />
Positive Living. A practical guide for people<br />
<strong>with</strong> <strong>HIV</strong>. Seattle: <strong>Public</strong> Health–Seattle &<br />
King County, <strong>HIV</strong>/<strong>AIDS</strong> Program; 1999.<br />
2<br />
Rollnick S, Miller WR. What is motivational<br />
interviewing? Behavioral and Cognitive<br />
Psychotherapy. 1995;23:325-334.<br />
U.S. Department <strong>of</strong> Health and Human Services, Health Resources and Services Administration, <strong>HIV</strong>/<strong>AIDS</strong> Bureau<br />
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