In a study of patients at two HIV clinics in the Houston area, researchers at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center found that those who were satisfied with the care they received had higher adherence to care and higher retention rates. Their report appears today in PLOS ONE.
"Poor retention is a big problem with HIV care," said Dr. Bich Dang, instructor of medicine – infectious diseases at BCM and first author of the paper. "Even though there are about 1.1 million patients in the United States with HIV, many of them are not in care and only about 60 percent of patients who know their HIV status get regular HIV care."
Past studies have shown that patients who don't get regular HIV care have worse survival rates and that poor retention predicts mortality.
"Even though we have all these effective treatments out there, patients aren't using them – we're not maximizing the benefit of all this therapy," said Dang.
With this in mind, Dang and colleagues sought to find out whether satisfaction served as a focus for keeping patients in HIV care. They surveyed patients at Harris Health System's Thomas Street Health Center, a clinic devoted to treating patients with HIV, as well as HIV patients at the DeBakey VA.
"We measured patient satisfaction with clinical services, and analyzed whether satisfaction was associated with their adherence to antiretroviral therapy and their retention in HIV care – both of which are critical for achieving control of HIV infection," said Dr. Thomas Giordano, associate professor of medicine – infectious diseases at BCM and senior author of the paper.
They found that at both clinics, patients who were more satisfied with their care were more likely to adhere to their medications and be retained in their HIV care, meaning that they kept their regular clinic appointments. Together both of those predicted whether the person did well with their HIV therapy. The ones that were unsatisfied with their care were the ones who were more likely to miss their appointments.
"It showed that if you're happy with the overall clinical services that you get, you appear to have higher adherence to the medical treatment plan and you can do better clinically," said Giordano, who is also medical director of the Thomas Street Health Center. "What's unique about this study is that we're measuring the patient's perception of how satisfied they are with care. If you can simply improve the customer experience without necessarily changing the care you deliver, patients might do better."
Dang says the next step in the study is to take this further and try to understand what part of the patient care experience is the most important for patients when they think about their overall satisfaction. They can then develop an intervention to try to improve that part of care.
"It's a neat way to improve medical outcomes – by providing better customer service without changing the quality of care," said Giordano.
Both Dang and Giordano are with the Houston VA Health Services Research and Development Center of Excellence at the DeBakey VA Medical Center.