Patients With HIV Will Forgo Short Wait Time, Travel Distance to Access Nice Providers

August 28, 2018

Patients with HIV indicated a strong preference for “nice” over “rude” providers and a willingness to wait 19 hours more or travel 28 miles farther to see nice rather than rude providers.

It’s no secret that empathy and positivity go a long way. Now, new research points to these attributes having far reaching effects in healthcare and adherence to care, specifically for patients with HIV. The study's findings go as far as showing that patients with HIV will forgo short travel distances and wait times in order to access a healthcare provider with a positive attitude.

These findings not only reveal the value of a nice attitude, it also opens the door toward understanding what people want from health services in resource-limited settings, which has implications for addressing the challenge of engaging patients with HIV in their care, the researchers note.

In order to sustain engagement with these patients, healthcare providers have implemented several strategies, such as reducing visit frequency and expanding hours of operation, but as most of these providers are in resource-limited environments, they cannot implement all strategies simultaneously. However, information on what to prioritize has remained unknown so far.

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For their present study, the researchers identified a group of 280 HIV patients who were lost to follow-up, defined as over 90 days late for their last scheduled appointment. Based on initial interviews, researchers identified emergent themes of barriers, including: waiting time at the clinic (1, 3, or 5 hours), distance from residence to clinic (3, 6, or 12 miles), antiretroviral therapy supply given at each refill (1, 3, and 5 months), hours of operation (morning only, morning and afternoon, or morning and Saturday), and staff attitude (“rude” or “nice”).

Taking these in to consideration, 2 hypothetical clinics were created in which the 5 attributes were variably implemented. Participants filled out the survey between December 9, 2015, and May 31, 2016. Of the participants, 170 (61%) were not in care and 110 (39%) had reconnected to care by the end of the study.

Findings yielded strong patient preference for “nice” over “rude” providers and a willingness to wait 19 hours more or travel 28 miles farther to see nice rather than rude providers. In a trade-off analysis, patients indicated they would go to a facility 6 miles from home (as opposed to 3) that required 5 hours of waiting per visit (as opposed to 1 hour) and that dispensed 3 months of medications (instead of 5) in order to be treated by a nice provider (as opposed to a rude one).

The researchers point out that the biggest takeaway from the study that points to new directions for public health innovations has historically received little attention: improving healthcare provider morale, attitude, and communication skills.

“To me, the findings further the idea that everyone wants to be treated fairly and with respect,” said Elvin Gene, MD, MPH, professor of medicine, University of California San Francisco, and lead author of the study, in a statement.

Reference

Zanolini A, Sikombe K, Sikazwe I, et al. Understanding preferences for HIV care and treatment in Zambia: Evidence from a discrete choice experiment among patients who have been lost to follow-up [published online August 13, 2018]. PLOS Med. doi: https://doi.org/10.1371/journal.pmed.1002636.