Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?
- 301 Downloads
PURPOSE: Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being “known as a person” and receipt of highly active antiretroviral therapy (HAART), adherence to HAART, and health outcomes among patients with HIV.
STUDY DESIGN: Cross-sectional analysis.
SUBJECTS: One thousand seven hundred and forty-three patients with HIV.
MEASUREMENTS: Patient reports that their HIV provider “knows me as a person” and 3 outcomes: receipt of HAART, adherence to HAART, and undetectable serum HIV RNA.
RESULTS: Patients who reported that their provider knows them “as a person” were more likely to receive HAART (60% vs 47%, P<.001), be adherent to HAART (76% vs 67%, P=.007), and have undetectable serum HIV RNA (49% vs 39%, P<.001). Patients who reported their provider knows them “as a person” were also older (mean 38.0 vs 36.6 years, P<.001), reported higher quality-of-life (mean LASA score 71.1 vs 64.8, P<.001), had been followed in clinic longer (mean 64.4 vs 61.7 months, P=.008), missed fewer appointments (mean proportion missed appointments 0.124 vs 0.144, P<.001), reported more positive beliefs about HAART therapy (39% vs 28% strongly believed HIV medications could help them live longer, P<.008), reported less social stress (50% vs 62% did not eat regular meals, P<.001) and were less likely to use illicit drugs or alcohol (22% vs 33% used drugs, P<.001; 42% vs 53% used alcohol, P<.001). Controlling for patient age, sex, race/ethnicity, quality-of-life, length of time in clinic, missed appointments, health beliefs, social stress, and illicit drug and alcohol use, patients who reported their provider knows them “as a person” had higher odds of receiving HAART (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19 to 1.65), adhering to HAART (OR 1.33, 95% CI 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% CI 1.02 to 1.41).
CONCLUSIONS: We found that a single item measuring the essence of patient-centeredness—the patients’ perception of being “known as a person”—is significantly and independently associated with receiving HAART, adhering to HAART, and having undetectable serum HIV RNA. These results support the hypothesis that the quality of patient-physician relationship is directly related to the health of patients.
Key wordspatient-physician relations patient-centeredness HIV, HAART adherence quality of care
- 1.Balint E. The possibilities of patient-centred medicine. J Roy Coll Gen Pract. 1969;17:269–76.Google Scholar
- 2.Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.Google Scholar
- 7.Stewart MA. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423–33.Google Scholar
- 10.Murri R, Antinori A, Ammassari A, et al. Physician estimates of adherence and the patient-physician relationship as a setting to improve adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):158-S162.Google Scholar
- 11.Wu AW, Ammassari A, Antinori A. Adherence to antiretroviral therap: where are we, and where do we go from here? J Acquire Immune Defic Syndr. 2002;31(Suppl 3):95-S97.Google Scholar
- 18.Moore RD. Understanding the clinical and economic outcomes of HIV therapy: the Johns Hopkins HIV clinical practice cohort. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17(Suppl 1):38-S41.Google Scholar
- 19.U.S. Department of Health and Human Services (DHHS). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. [cited 2005 Apr. 13]; Available from URL:http://aidsinfo.nih.govGoogle Scholar
- 20.Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient care committee & adherence working group of the outcomes committee of the adult AIDS clinical trials group (AACTG). AIDS Care. 2000;12:255–66.CrossRefPubMedGoogle Scholar
- 23.Lewin S, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations (Cochrane Review). The Cochrane Library. Issue 2 ed. 2002.Google Scholar