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.
Introduction While studies have demonstrated hypoglossal nerve stimulation (HNS) to be a safe and overall effective treatment for certain patients with obstructive sleep apnea (OSA), not all who meet ...current selection criteria respond to therapy. In an effort to elucidate better criteria for patient selection, this study aimed to look at the effect of sleeping position - specifically, supine and non-supine positions - on the efficacy of HNS therapy. Given that the collapsibility of the upper airway is increased in the supine position due to the influence of gravity on the shape and size of the airway, we hypothesized that supine position would correlate with lower HNS efficacy, as measured by apnea-hypopnea index (AHI), as compared to non-supine position. Methods We performed a chart review of all patients implanted with HNS at Stanford University Medical Center since 2015. Patients with pre- and post-operative in-lab polysomnography (PSG) performed within the institution were included in the study. Baseline and treatment supine AHI and non-supine AHI were measured. Student’s paired t-test was used to compare the percent improvement in AHI from baseline to treatment between supine and non-supine positions. Results Eleven consecutive patients meeting inclusion criteria were selected for this preliminary analysis. Analysis showed a significantly greater mean reduction in non-supine AHI (82.8%) compared to supine AHI (32%) (p = 0.012). Conclusion Our results suggest that HNS may be less effective in the supine position, supporting the importance of evaluating sleeping position preference during patient selection. This study adds to the growing body of literature investigating elements that may hinder the success of HNS therapy. Support (If Any) N/A
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