Switch On Your HIV Smarts.

Better Patient-Provider Relationships Linked with Fewer Missed Appointments

, by Reilly O'Neal

For people living with HIV, regular medical care is essential to starting and sustaining antiretroviral therapy (ART) and maintaining good health. But obstacles like inadequate insurance, stigma around seeking HIV treatment, and even lack of transportation can cause people to fall out of medical care and put them at risk for disease progression.

Another obstacle? Poor communication and weak relationships between providers and patients.  People who have better interactions with their providers miss fewer appointments, according to recent study.

The analysis, described by Tabor Flickinger of Johns Hopkins University School of Medicine and colleagues in the April 15 issue of the Journal of Acquired Immune Deficiency Syndromes, involved 1,363 individuals in the Johns Hopkins HIV Clinical Cohort in Baltimore, Maryland. Researchers investigated links between participants’ “appointment adherence” (the proportion of medical appointments they kept rather than missed) and their responses to questions and prompts about their relationships with their medical providers:

  • Does your HIV provider treat you with respect and dignity?
  • Does your HIV provider involve you in decisions about your care?
  • My HIV provider explains things in a way I can understand.
  • My HIV provider listens carefully to me.
  • My HIV provider really knows me as a person.

For all patients in the study, the mean appointment adherence was 65%. Appointment adherence was associated with several factors, including being male, being white, taking antiretroviral therapy, and not using substances. After adjusting for these and other demographic factors, patient-provider communication and relationships showed significant associations with appointment adherence.

“[P]atients kept more appointments if providers treated them with dignity and respect, listened carefully to them, explained in ways they could understand, and knew them as persons,” the researchers report.  For example, individuals who said their providers always listened carefully to them kept 7% more of their appointments than individuals whose providers usually, sometimes, or never listened carefully to them. (Interestingly, being involved in decision-making was not significantly associated with appointment adherence.)

“Our study contributes new findings that after adjusting for demographics and substance use, communication and relationship factors were independent predictors of appointment adherence,” Flickinger and colleagues add.

How can these findings be put into practice in the doctor’s office? It comes down to recognizing “the unconditional value of patients as persons,” the authors suggest. “This respect for patients as persons may be manifested by particular provider behaviors, such as honoring patients’ autonomy, listening attentively to patients’ viewpoints, and explaining in ways that accurately match patients’ levels of understanding.”

Improving patient-provider relationships may have public health benefits, as well, since reduced viral load translates to less virus in the blood and genital fluids, and therefore reduced likelihood of HIV transmission. “This approach,” Flickinger and colleagues conclude, “may help address the important need for retention in HIV care, which is necessary to achieve treatment goals for individual patients and the public health goal of reducing the transmission, morbidity, and mortality of HIV.”

Resources for Individuals and Their Providers

Whether you sit on the exam table or in the clinician’s chair, these resources can help boost your communication skills during medical visits.

Reilly O’Neal is a freelance writer and former editor of BETA.


Flickinger, T. and others. Higher quality communication and relationships are associated with improved patient engagement in HIV care. Journal of Acquired Immune Deficiency Syndromes [Epub ahead of print]. April 15, 2013.


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