Journal of General Internal Medicine

, Volume 19, Issue 11, pp 1096–1103 | Cite as

Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection

  • John Schneider
  • Sherrie H. Kaplan
  • Sheldon Greenfield
  • Wenjun Li
  • Ira B. Wilson
Original Articles

Abstract

BACKGROUND: There is little evidence to support the widely accepted assertion that better physician-patient relationships result in higher rates of adherence with recommended therapies.

OBJECTIVE: To determine whether and which aspects of a better physician-patient relationship are associated with higher rates of adherence with antiretroviral therapies for persons with HIV infection.

DESIGN: Cross-sectional analysis.

SETTING: Twenty-two outpatient HIV practices in a metropolitan area.

PARTICIPANTS: Five hundred fifty-four patients with HIV infection taking antiretroviral medications.

MEASUREMENTS: We measured adherence using a 4-item self-report scale (α=0.75). We measured core aspects of physician-patient relationships using 6 previously tested scales (general communication, HIV-specific information, participatory decision making, overall satisfaction, willingness to recommend physician, and physician trust; α>0.70 for all) and 1 new scale, adherence dialogue (α=0.92). For adherence dialogue, patients rated their physician at understanding and solving problems with antiretroviral therapy regimens.

RESULTS: Mean patient age was 42 years, 15% were female, 73% were white, and 57% reported gay or bisexual sexual contact as their primary HIV risk factor. In multivariable models that accounted for the clustering of patients within physicians’ practices, 6 of the 7 physician-patient relationship quality variables were significantly (P<.05) associated with adherence. In all 7 models worse adherence was independently associated (P<.05) with lower age, not believing in the importance of antiretroviral therapy, and worse mental health.

CONCLUSIONS: This study showed that multiple, mutable dimensions of the physician-patient relationship were associated with medication adherence in persons with HIV infection, suggesting that physician-patient relationship quality is a potentially important point of intervention to improve patients’ medication adherence. In addition, our data suggest that it is critical to investigate and incorporate patients’ belief systems about antiretroviral therapy into adherence discussions, and to identify and treat mental disorders.

Key words

patient compliance HIV infections physician-patient relations HIV infections/drug therapy 

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Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • John Schneider
    • 4
  • Sherrie H. Kaplan
    • 3
  • Sheldon Greenfield
    • 3
  • Wenjun Li
    • 5
  • Ira B. Wilson
    • 1
    • 2
  1. 1.the Institute for Clinical Research and Health Policy StudiesTufts-New England Medical CenterBoston
  2. 2.Department of MedicineTufts-New England Medical CenterBoston
  3. 3.Health Policy and ResearchUniversity of California IrvineIrvine
  4. 4.Department of MedicineUniversity of ChicagoChicago
  5. 5.the Division of Preventive and Behavioral MedicineUniversity of Massachusetts Medical SchoolWorcester
  6. 6.New England Medical Center #345Boston

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