HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment.

BACKGROUND: Patient satisfaction is an important factor for both assessing the quality of healthcare and predicting positive health outcomes. This study assesses the influence of HIV/AIDS patients' perception of the quality of health services on adherence to antiretroviral treatment using the decentralized care model in Manaus, Brazil. METHODS: We conducted a non-randomized, cross-sectional analysis to explore the relationship between patient satisfaction and adherence to antiretroviral treatment (ART) in Manaus, Amazonas, Brazil. We also compared patient satisfaction levels at the city's main hospital with those at smaller health units established to decentralize HIV/AIDS healthcare. Using survey responses from 812 patients and health data from 713 patients, we conducted descriptive and regression analyses to identify health center characteristics associated with higher patient satisfaction and higher adherence to treatment. RESULTS: We found a clear and positive relationship between patient satisfaction with the quality of health services and adherence to ART. Patients who had better access to their health center and its services -mainly in the form of convenient location, shorter commute times, and shorter wait times- tended to rate the quality of services higher and were also more likely to adhere to ART. We also found higher levels of patient satisfaction and adherence to ART among patients served at decentralized health units than among patients served at the main hospital. CONCLUSIONS: The study's results emphasize the importance of patients' experience at the health center for improved health outcomes. While many of the factors that play a role in whether a patient adheres to ART or not are beyond the control of the health center, our findings highlight that health centers can importantly contribute to increased ART adherence by improving such experience. The study also showcases the potential benefits of decentralizing HIV care to increase patient satisfaction and, with it, adherence to ART.

Psychological Climate for Caring and Work Outcomes: A Virtuous Cycle.

The current literature's focus on unidirectional effects of psychological and organizational climates at work on work outcomes fails to capture the full relationship between these factors. This article examines whether a psychological climate for caring contributes to specific work outcomes and investigates whether work outcomes support the climate for caring, creating a feedback loop. Results confirm a bi-directional, temporal association between perceived climate for caring and two of the four explored work outcomes: self-reported productivity and self-reported work quality. The effect of a perceived caring climate on these work outcomes was stronger than the effect in the opposite direction. The perception that the work climate was caring was also found to affect work engagement, but the reverse relationship was not identified. We did not find any evidence for a link between job satisfaction and a climate for caring at work in either direction.