Researchers at Johns Hopkins University in Baltimore investigated whether the quality of patients’ relationships with their HIV care providers helped patients keep routine care appointments. They were looking for potential targets for future interventions to improve providers’ interactions with patients, promote retention in care, and help patients have better outcomes in HIV care. The researchers studied 1,363 of their clinic patients between 2004 and 2009. Participants were mostly male (65 percent), non-white (85 percent), and with a mean age of 46 years. Two-thirds were on antiretroviral therapy and 49 percent had undetectable viral load.
Each participant completed a computer-assisted questionnaire rating the quality of communication and relationship with their care providers in the following five areas: being treated with dignity and respect; being involved in decisions about care; feeling listened to; having information explained in a way that could be understood; and feeling known as a person. Researchers hypothesized that high ratings for doctors and healthcare providers would be associated with higher attendance levels at routine clinic appointments.
Participants rated their healthcare providers highly in all five areas, with 85–94 percent of patients giving the highest possible ratings. Results indicated that patients who believed that their healthcare providers really knew them as a person kept 6 percent more appointments than those who did not share that level of belief. Participants who gave highest ratings in terms of being treated with dignity and respect and always having information explained in a way that was understandable, and careful listening were 7, 7, and 6 percent more likely to keep their appointments, respectively, than those who gave lower ratings in these areas. High rating for involvement in decision making was not associated with higher levels of attendance at appointments.
The results surprised researchers. When they included all communication and relationship variables into a single model, which they adjusted for demographic factors and substance use, “feeling known as a person” was the only factor associated with significantly higher rates of clinic attendance. Researchers concluded that the study suggests that healthcare providers could enhance appointment adherence by improving the quality of relationships, so that patients feel known and respected as persons by them. Also, provider communication behaviors such as listening and carefully explaining could make a difference in retaining patients in care.
The full report, “Higher Quality Communication and Relationships are Associated with Improved Patient Engagement in HIV Care,” was published online in the Journal of Acquired Immune Deficiency Syndromes (2013; doi: 10.1097/QAI.0b013e318295b86a).