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2015 HSR&D/QUERI National Conference Abstract

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1043 — Provider Traits that Patients Value Most and the Implications for Enhanced Engagement in their Own Care: A Longitudinal Qualitative Study

Dang BN, Houston VA Center for Innovations in Quality, Effectiveness and Safety; Westbrook R, Rice University; Giordano TP, Houston VA Center for Innovations in Quality, Effectiveness and Safety;

Objectives:
Understanding Veterans' value proposition is crucial to creating patient-centered approaches to improving HIV care experiences and outcomes. This study identifies provider attributes most salient to patients' own engagement in their HIV care.

Methods:
We conducted semi-structured interviews with 21 veterans new to the HIV clinic at the Michael E. DeBakey VA Medical Center in Houston, Texas. We interviewed veterans before their first provider visit, again within two weeks of the first visit, and again at 6-12 months. Interviewing continued until we reached thematic saturation. Interviews were analyzed using directed and conventional content analysis.

Results:
Veterans described anxiety and vulnerability stemming not only from their HIV diagnosis, but also in the context of being a new patient to a new provider. For some, the idea of having to rehash their HIV story was particularly anxiety-provoking. Veterans also described anxiety over whether or not their HIV virus was still undetectable. For those patients, knowing that their labs looked good was not enough. They wanted to visually see their lab results on the computer screen and know what those results mean. Participants cited positive experiences with the provider as critical to mitigating those feelings of anxiety and vulnerability. Provider-initiated steps to facilitate patient engagement in their HIV care included: reassurance, involving patients in decisions about their care, explaining lab results in a way patients can understand, and making patients feel comfortable asking questions and expressing concerns.

Implications:
To provide patient-centered care, providers must be attuned to the medical and psychological challenges Veterans face in seeking care from a new HIV provider. Providers can foster patient engagement by creating an environment that encourages patients to take a proactive role in their own HIV care. This in turn may mitigate feelings of anxiety and vulnerability and ultimately improve patients' HIV care experience.

Impacts:
As one of the largest providers of HIV care in the US, VA is in a unique position to positively impact the quality of HIV care. This study incorporates direct input from Veterans and highlights attributes of the provider that Veterans value most in evaluating their HIV care experience.