title: Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  One thousand seven hundred and forty-three patients with HIV.
  
  
  METHODS
  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<.001), 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 [CI] 1.19 to 1.65), adhering to HAART (OR 1.33, 95% CI 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% CI 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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. mcbeach@jh-mi.edu
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Jeanne
authors.initials: J
authors.lastname: Keruly
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D044469:Racial Groups; D013315:Stress, Psychological; D016896:Treatment Outcome