title: Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences.
abstract: Cross-sectional studies have shown an association between better patient experiences and health outcomes. However, the direction of causality remains unclear. Our prospective study seeks to determine whether better initial patient experiences predict subsequent retention in HIV care. We enrolled patients new to an HIV clinic in Houston, Texas, from August 26, 2013 to November 18, 2013. The patients' overall experience with the HIV provider was based on six items; overall experience with the HIV clinic was based on five items. We measured subsequent retention over the first 6 months and entire first year of HIV care. Analyses included 140 patients. Sixty-one percent were non-Hispanic black, 41 % were diagnosed with HIV within the last 3 months, and 36 % had a CD4 cell count <200. Thirty three percent were totally satisfied with their initial HIV provider experience and 32 % were totally satisfied with their initial HIV clinic experience. Retention was 68 % over the first 6 months and 51 % over the first year. Satisfaction with the HIV provider at the initial visit significantly predicted 6-month retention in care (aOR = 3.56, p = 0.006). Similar results were found for satisfaction with the HIV clinic (aOR = 4.67, p = 0.002). Neither of the patient experience measures at the initial visit predicted 12-month retention. Patients with better initial care experiences have significantly greater retention in HIV care. The effect of better initial care experiences was limited in duration. Consistently improving patient care experiences, not only at baseline but also on subsequent visits, may be a way to increase retention in HIV care.
authors.affiliation: VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA. bndang@bcm.edu.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. bndang@bcm.edu.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA. bndang@bcm.edu.|Harris Health System, Houston, TX, USA. bndang@bcm.edu.
authors.forename: Bich N
authors.initials: BN
authors.lastname: Dang
authors.affiliation: Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Westbrook
authors.affiliation: VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hartman
authors.affiliation: VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA.|Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|Harris Health System, Houston, TX, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D005791:Patient Care; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011446:Prospective Studies; D013781:Texas; D035502:Trust
keywords: HIV infection; Patient experience; Patient satisfaction; Prospective studies; Retention in care