Measuring health risk assessment and conselling recommendations can be challenging. In this study, unannounced standardized patients (lay individuals trained to replicate a clinical encounter consistently) were used to evaluate HIV preventive performance of 22 family nurse practitioners (NPs) and family physicians. Standardized patients were trained to present an identical scenario of a heterosexual individual at risk for HIV exposure. Audiotaping via a hidden microphone and recorder was used to validate the reproduclbility of clinical encounters and accuracy of standardized patient assessment. Standardized patients were highly accurate in both case protrayal and assessment activities with an indexed Kappa coefficient of 0.82. Determining risk, including condom use, sexual orienttation, and number of past sexual partners, was performed less often than experts advise by both physicians and NPs (done between 9% and 63% of encounters). Providing patient education to reduce risk, including educating about abstinence, mutual monogamy, and limiting sexual partners, was also done in only 9% to 36% of encounters. The methodology used was innovative. There is room for improvement in the provider participants' clinical performance of HIV risk assessment, patient education, and counseling. However, the results of this case study cannot be generalized.
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