摘要：Objectives. We used longitudinal data to examine the roles of 4 dimensions of patient satisfaction as both predictors and outcomes of use of highly active antiretroviral therapy (HAART) among women in the United States with HIV/AIDS. Methods. Generalized estimating equations were used to analyze time-lagged satisfaction–HAART relationships over 8 years in the Women’s Interagency HIV Study. Results. Multivariate models showed that, over time, HAART use was associated with higher patient satisfaction with care in general, with providers, and with access/convenience of care; however, patient satisfaction was not associated with subsequent HAART use. Symptoms of depression and poor health-related quality of life were associated with less satisfaction with care on all 4 dimensions assessed, whereas African American race/ethnicity, illegal drug use, and fewer primary care visits were associated with less HAART use. Conclusions. Our findings suggest that dissatisfaction with care is not a reason for underuse of HAART among women with HIV and that providers should not be discouraged from recommending HAART to dissatisfied patients. Rather, increasing women’s access to primary care could result in both increased HAART use and greater patient satisfaction. In the United States, women with HIV infection are less likely than men with the disease to use various types health care services and treatments, including combination antiretroviral therapy. 1 , 2 Given this disparity and the demonstrated effectiveness of highly active antiretroviral therapy (HAART) in reducing HIV morbidity and mortality, 3 , 4 it is important to evaluate quality of care among women with HIV/AIDS and to examine factors that may lead to improved care and outcomes. Satisfaction with care is variously considered to be a health outcome, a quality of care indicator, and a predictor of patient behavior. Patient satisfaction is one of the most commonly measured outcomes of patient care other than mortality and morbidity. 5 Wu and colleagues recommended that patient satisfaction, along with measures of health status and essential care processes, be used as a quality of care indicator for adults with HIV/AIDS. 6 In addition, there is extensive research demonstrating the association between measures of satisfaction and patient behaviors (e.g., use of primary care) and clinical outcomes. 7 – 11 In all of these roles, satisfaction can be thought of as a social construct negotiated between consumers and providers of health care, as well as a necessary component of and an outcome of effective care. 12 Although the meaning and interpretation of patient satisfaction remain a matter of debate, 8 there is consensus that patient satisfaction is a measurable concept comprising multidimensional elements such as access to care, quality of the provider–patient interpersonal relationship, and affordability of care. 7 , 8 , 12 Research also has established that variations in satisfaction with health care often involve patient sociodemographic or psychosocial characteristics. For example, in a meta-analysis of more than 220 studies, Hall and Dorman found that numerous patient demographic characteristics predicted care satisfaction, including older age, low education levels, being married, and higher social status, although these relationships varied across racial/ethnic and gender groups. 13 In a study of satisfaction with care among women with HIV/AIDS, Burke et al. found that levels of patient satisfaction varied across different dimensions of care. 14 In the same study, some patient characteristics were associated with lower satisfaction across multiple dimensions of care, including the presence of depressive symptoms, poor self-reported health, lack of a regular health care provider, Hispanic/Latina race/ethnicity, and nonuse of antiretroviral therapy. Satisfaction with care among patients with HIV/AIDS has been shown to be associated with adherence to antiretroviral therapy 15 , 16 but has seldom been studied in relationship to other patient behaviors such as use of HAART. Given the ongoing importance of HIV/AIDS as a women’s health issue 17 and evidence that HAART is underused among women, 1 , 18 we examined the role of satisfaction with care as both a predictor and an outcome of HAART use. Absent a randomized controlled experiment, evidence of causality is best inferred from analyses of temporal relationships, such as those revealed in longitudinal cohort data. 4 Study of long-term temporal relationships in a prospective cohort might clarify the role of patient satisfaction as a predictor of patient behaviors as well as an outcome of care. We addressed 2 research questions: (1) Are there dimensions of patient satisfaction related to subsequent HAART use? and (2) Does HAART use influence dimensions of subsequent patient satisfaction?
