If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient-provider relationship

• Published in: Patient preference and adherence 2018-01, Vol.12, p.919-927
• Main Authors: Wood, Troy J, Koester, Kimberly A, Christopoulos, Katerina A, Sauceda, John A, Neilands, Torsten B, Johnson, Mallory O
• Format: Article
• Language: English
• Subjects: Chronic diseases; Diseases; engagement in care; focus groups; Health aspects; HIV; HIV patients; Original Research; Psychotherapy; therapeutic alliance
• ISSN: 1177-889X; 1177-889X
• DOI: 10.2147/PPA.S157003

The patient-provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient-provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient-provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. The majority of participants emphasized how a strong patient-provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient-provider relationship impeded engagement. We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient-provider relationship and contend that a strong patient-provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care.