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Comparative Study
. 2009 Jan;24(1):80-5.
doi: 10.1007/s11606-008-0841-4. Epub 2008 Oct 30.

Behavioral indices in medical care outcome: the working alliance, adherence, and related factors

Jairo N Fuertes  1 , Laura S Boylan, Jessie A Fontanella
Affiliations
Comparative Study

Behavioral indices in medical care outcome: the working alliance, adherence, and related factors

Jairo N Fuertes et al. J Gen Intern Med. 2009 Jan.

Abstract

Background: The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome.

Objective: Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment.

Design: The study was based on an ex-post facto field correlation design.

Participants: One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study.

Interventions: Surveys given to participants.

Measurements: We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire.

Main results: The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49).

Conclusions: Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes.

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Figures

Figure 1
Figure 1
Model of patient satisfaction with standardized coefficients. Continuous lines note significant paths. Dashed lines note non-significant paths. Note **  < 0.001, * < 0.05
Figure 2
Figure 2
Model of patient adherence with standardized coefficients. Continuous lines note significant paths. Dashed lines note non-significant paths. Note **  < 0.001, * < 0.05
See this image and copyright information in PMC

References

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