Take Your Medicine

Based on research by Robert A. Westbrook, Bich N. Dang, William C. Black, Maria C. Rodriguez-Barradas and Thomas P. Giordano

• HIV now can be managed with antiviral drugs. But there are new obstacles to treating it.
• HIV patients don’t always seek regular medical care or properly taking their medicine.
• When patients are satisfied with their care, however, they’re more likely to comply with treatment plans.

Would you recommend your doctor to a friend? How do you feel about your medical care? The answers, it turns out, may predict how well you heal.

In 1987, six years after the first reported case of AIDS, the Federal Drug Administration approved a pioneering antiviral cocktail to treat the disease. Since then, medical advances have made it possible to keep HIV from becoming AIDS. Yet of the nearly 1 million people in the United States who are HIV positive, only a quarter actually achieve what clinicians call HIV “suppression,” that is, glancingly low levels of HIV in their systems.

For those who came of age during HIV’s darkest days, the issue is confounding. Now that there’s a way to manage this once-deadly disease, why do so few people use it?

In 2013, Robert A. Westbrook, a professor at the Rice Business school, joined Bich N. Dang and Thomas P. Giordano, clinicians and instructors at Baylor College of Medicine, to tackle two of the biggest challenges in HIV patient compliance. Current mainstream treatment, they knew, stresses keeping HIV-infected patients in a physician’s care and getting them to correctly follow highly active antiretroviral therapy, or HAART.

But both goals are surprisingly hard to achieve. Of those HIV-diagnosed patients who are linked to care, many don’t stay: Only 60 percent of HIV-positive patients seek routine clinical care. Getting patients to adhere to their antiretroviral therapy is also a conundrum: Just 55 percent of those with HAART actually take their meds as prescribed.

If clinicians and policymakers want to improve outcomes, Westbrook and his colleagues argued, caregivers will have to attack these two problem areas. Previous market research offers a clue about how to do it. In general, the studies show, patient satisfaction correlates to patient retention and medication adherence. Perhaps, the team hypothesized, patient satisfaction could influence HIV treatment as well.

To find out, the researchers analyzed survey data from almost 500 patients at two different clinics. The subjects were mostly minority and low-income patients — the population most affected by HIV, and most prone to adherence problems and worse outcomes. Their satisfaction as patients was measured by their willingness to recommend the clinic and their overall feelings about the care they got there in the 12 months before the survey.

The findings were striking. Patient satisfaction did indeed correlate with retention and adherence to HAART. This, in turn, improved HIV suppression. Based on these results, the scholars concluded that any treatment designed to improve HIV suppression also needs to factor in the patients’ experience. Caregivers can be trained in patient-centered communication. Providers can ask patients about their treatment goals and preferences — and they can ask, more frequently, if the patients have any questions. Clinics can arrange for patients to get their ongoing care with the same clinician.

Bolstered by this research, the researchers suggested that not only HIV clinics but all healthcare providers who care about better outcomes should work to promote patient satisfaction. Helping patients feel cared for, it turns out, actually helps them to heal.

Robert A. Westbrook is the William Alexander Kirkland Professor of Business at Jones Graduate School of Business at Rice University.

To learn more, please see: Dang, B. N., Westbrook, R. A., Black, W. C., Rodriguez-Barradas, M. C., & Giordano, T. P. (2013). Examining the link between patient satisfaction and adherence to HIV care: A structural equation model. PLOS ONE, 8(1).