Biomedical markers, adherence myths, and organizational structure: A two-stage model of HIV healthcare provider decision making

This study developed a two-stage model of decision making used by healthcare providers when considering combination antiretroviral therapy for HIV-positive patients. Provider interviews and patient medical records from 10 HIV-positive patients were utilized. Four providers (two nurse practitioners and two physicians' assistants) situated in two managed care HIV clinics were studied. Newly diagnosed HIV patients were observed while interacting with their health care provider. Following the interactions, healthcare providers were given a semistructured private interview about the factors that influenced their treatment decisions. It was hypothesized that providers, when they made their treatment decisions, would initially evaluate biomedical markers followed by an evaluation of patient characteristics associated with treatment adherence. It was found that providers developed basic decision-making principles and perceived some decisions as relatively easy and others as much harder. The easiest decisions conformed to biomedical guidelines while the harder ones had substantial behavioral and nonmedical components. These were hard decisions because they were perceived as making treatment regimen adherence much more problematic. It was also found that the providers' high level of decisionmaking responsibility combined with their relatively low authority contributed to their decision-making uncertainty.