284466
Role of patient treatment beliefs and provider characteristics in establishing treatment alliance
James Coyne, PhD,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Purpose. Positive treatment alliance is associated with improved treatment outcomes for individuals with depression. Little is known about how patient treatment beliefs influence treatment alliance. We evaluated the relationship between patient beliefs about treatment and treatment alliance, examining potential differences by gender, race, and current diagnosis of depression. Methods. We used an embedded concurrent mixed methods study design to collect cross-sectional descriptive data from 227 Black and White primary care patients presenting with depression symptoms in primary care settings in a large urban hospital network. Individuals were randomized into either the survey (198) or interview (29) arms. We used multiple/ordinary least squares regression to evaluate the association between patient beliefs and treatment alliance. To complement these findings we conducted thematic analyses of qualitative data which was managed using Atlas.ti. Results. Patients who believed their providers would respectfully facilitate depression treatment reported higher bond, confidence, and openness with their provider. Current depression diagnosis decreased, but did not eliminate the effect of patients' belief on their openness with their providers. This was echoed in the qualitative findings in which listening and perception that the physician cared about the patient were predominant themes. Conclusions. Creating primary care environments where individuals feel safe in sharing psychological distress is essential in early identification and treatment of depression. Increasing provider empathy and emotive expression increases patients' trust in primary care physicians as facilitators of depression treatment. Skills based training of physicians in attentiveness and active listening will influence effectiveness in depression intervention.
Learning Areas:
Chronic disease management and prevention
Diversity and culture
Provision of health care to the public
Social and behavioral sciences
Learning Objectives:
Differentiate four components of treatment alliance
Identify the patient and provider factors most relevant to developing treatment alliance in primary care
Assess the impact of patient and provider gender, race, and current depression status in developing treatment alliance in primary care
Keyword(s): Depression, Primary Care
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I was a data collector on the project and the lead for the qualitative analyses and write up.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.