Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?

Beach, Mary Catherine; Keruly, Jeanne; Moore, Richard D.
June 2006
JGIM: Journal of General Internal Medicine;Jun2006, Vol. 21 Issue 6, p661
Academic Journal
journal article
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<.00 1). 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 (Cl) 1.19 to 1.65), adhering to HAART (OR 1.33, 95% Cl 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% Cl 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.


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