Physician-Patient Communication Linked to HIV Treatment Retention

Compliance with treatment and follow-up care can be challenging with many HIV patients. Several studies showed that up to 30% of scheduled appointments are missed by patients receiving HIV care.¹ It is well known, too, that poor adherence to clinic visits is an independent predictor of virologic failure and death in patients receiving antiretroviral therapy.²

Previous studies have focused on patient-related factors as barriers to adherence and retention but have not shed enough light on the importance of the physician-patient relationship in the HIV care setting. A recent study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) examined the correlation between patients’ perception of their providers and adherence to treatment appointments.³  In response to a questionnaire, patients used Likert-type scales to rate their physicians on 5 domains: 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.

In a cohort of 1,363 patients, the investigators found an adherence rate of 65%, similar to what has been reported in other studies. The study showed that patients were more likely to adhere to appointments when they felt that their providers knew them as persons; always treated them with respect and dignity, always explained things in ways they could understand, and always listened carefully to them. However, after adjusting for demographics, patients’ perception of being known as persons by their providers was the only factor that was significantly associated with appointment adherence.³ It is possible that “ feeling known as a person” is a surrogate for other dimensions of the physician-patient relationship and signifies respect for the patient.⁴ Of particular interest was the finding that being involved in decisions about care was not significantly associated with adherence to appointments in this study.³

These results demonstrate a positive association between a meaningful physician-patient relationship and adherence with HIV care. Primary care physicians are involved more and more along the continuum of care for this once-deadly and now chronic disease. Honing interpersonal communication skills such as listening and explaining may have an important effect on patients’ willingness to participate in treatment.

References
1. Traeger L, O'Cleirigh C, Skeer MR, et al. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2011;35:548–556. (Abstract)
2. Mugavero MJ, Lin HY, Allison JJ, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50:100–108. (Full text)
3. Flickinger TE, Saha S, Moore RD, Beach MC. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr. 2013;63:362-366. (Abstract)
4. Beach MC, Duggan PS, Cassel CK, et al. What does “respect” mean? Exploring the moral obligation of health professionals to respect patients. J Gen Intern Med. 2007;22:692–695. (Full text)