Social vulnerability associated with lack of satisfaction with health care; doctors need to provide more support

Patients who are socially disadvantaged or who lack social support tend to be less satisfied with the health care they receive, French researchers report in AIDS Care. The authors suggest that clinicians need to make extra efforts with such patients in order to achieve good outcomes.

Several previous studies have shown that people who are satisfied with their health care have better quality of life, are more likely to adhere to their medication and less likely to drop out of contact with the health care system.

Moreover an American study found that patients with HIV who were comfortable discussing personal issues with their doctor, who perceived their doctor as more empathetic or who perceived their doctor to be knowledgeable about HIV were more satisfied with their care.

The new data is drawn from the APROCO-COPILOTE cohort, a group of individuals who began combination therapy in France in the late 1990s. A previous analysis of data from the cohort, examining changes over a five year period, found that while the vast majority of patients trusted their doctors, in a small number of cases, there was a loss of trust. This was more likely to occur to younger people and people with a lot of side-effects. Moreover, individuals who were not convinced that anti-HIV treatment was beneficial and those dissatisfied with the explanations provided by medical staff were more likely to lose trust.

In the new analysis, the researchers wished to examine social and structural factors which may influence people with HIV’s satisfaction with care. Whereas previous analyses from this cohort have looked at changes over the time, the current study concerns only cross-sectional data collected in the ninth year of the study.

Participants completed a survey which included assessments of satisfaction with care, quality of life, adherence, social support, housing conditions, depressive symptoms and social vulnerability.

410 individuals who were still in the cohort completed the questionnaire. This is a predominantly male, middle-aged cohort, including relatively few women (21%), people born outside Europe (20%), injecting drug users (13%) and people who also have hepatitis C (18%).

Satisfaction with doctors and satisfaction with services and organization were assessed separately. However for both, 48% of respondents expressed overall or complete satisfaction.

The older a person was, the more likely they were to be satisfied with both doctors and services. The authors suggest that older patients have had the time to acquire skills in managing their illness, communicating with doctors and dealing with the healthcare bureaucracy.

Whereas educational achievment was not associated with differences in satisfaction ratings, people who had good housing were twice as likely to be satisfied with healthcare services as others (odds ratio 1.9).

Furthermore, social support was associated with satisfaction with care. People with strong support from friends were twice as likely to be satisfied with their doctor, while those with strong support from family were twice as likely to be satisfied with services.

On the other hand, being in a couple or having a supportive partner wasn’t associated with differences in satisfaction.

The authors suggest that patients with good social support have other opportunities to talk about their infection and get help.

“On the contrary, patients without social support from family or friends have probably greater needs in terms of social support by physicians and the organization of care,” they say. If these needs are not met, these patients are more likely to be dissatisfied with care.

The fewer side effects a person had, the more likely they were to be satisfied with both doctors and services. Moreover, people with hepatitis C were much less likely to express satisfaction with doctors than other people (odds ratio 0.3).

The authors say that their findings show that social vulnerability represents a significant barrier to building a satisfying doctor-patient relationship. Clinicians should give particular attention to developing productive relationships with patients living with difficult social conditions.