Dang Bich N, Westbrook Robert A, Njue Sarah M, Giordano Thomas P
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.
BMC Med Educ. 2017 Feb 2;17(1):32. doi: 10.1186/s12909-017-0868-5.
New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.
We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit.
We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences].
Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients' feelings of anxiety and vulnerability, and thereby improve their overall health care experience.
新患者是一个特别脆弱的群体，因为他们极有可能错过后续就诊或完全退出治疗。然而，关于新患者在与新医疗服务提供者建立关系之初看重什么的数据却很少。感染艾滋病毒的人可能是研究积极的医患关系初期驱动因素的理想人群，因为这是一种慢性且严重的疾病，需要与医疗服务提供者建立可靠的持续关系。基于患者的真实经历，本研究旨在确定患者认为从一开始就建立信任和融洽关系的最关键要素。
2013年8月至2015年3月，我们对得克萨斯州休斯顿迈克尔·E·德贝基退伍军人事务医疗中心艾滋病毒诊所的21名新患者进行了纵向的面对面访谈。患者在三个时间点接受访谈：第一次就诊前一次，第一次就诊后两周内第二次，第一次就诊后6至12个月第三次。
我们进行了61小时的患者访谈。平均年龄为53岁；52%为非西班牙裔白人，23%为非西班牙裔黑人，19%为西班牙裔。患者表示不仅因艾滋病毒本身，而且作为新患者与新医疗服务提供者建立关系时都感到极大的焦虑和脆弱。我们对这些经历的分析揭示了医疗服务提供者可以采取的五项行动，以减轻患者的焦虑并在首次就诊时尽早建立信任：1）向患者提供安慰；2）告诉患者可以提问；3）向患者展示他们的实验室检查结果并解释其含义；4）避免对患者进行评判的语言和行为；5）询问患者想要什么[即治疗目标和偏好]。
我们的研究纳入了患者的直接意见，并突出了患者在寻求新医疗服务提供者治疗时面临的独特心理挑战。患者提到的可采取行动的机会有可能减轻患者的焦虑和脆弱感，从而改善他们的整体医疗体验。
