Individualized patient care and clinical outcomes in HIV/AIDS management

INTRODUCTION

Individualized care can be considered a turning point in health-care delivery. It entails putting into consideration the patient’s desires, lifestyles, social circumstances, values, and peculiar family situations in the provision of health-care services. It involves developing and implementing health-care services that put the patients and their families at the center of health-care decisions. It is focused on meeting patients’ individual needs. In providing individualized care, clinicians view the patients as experts and work with them to achieve desired therapeutic outcomes.^[1,2]

Individualized care does not imply giving the patients whatever they want, but it involves seeing the patients as equal partners in developing, implementing, and monitoring health-care services. In providing individualized care, health-care providers should respect the views of the patients on issues of their health, take into account their expressed needs and preferences, and work with them to achieve treatment goals.^[1,2]

The engagement of patients in the provision of care has been identified as an important component of clinical practice in many advanced health-care systems.^[3,4] It is increasingly becoming a standard of care in many health-care settings and has been described as a proactive attempt by patients to bridge the gap between their expectations or preferences in the care relationship and what they experience during consultation with their health-care provider.^[3,5] Research findings suggest that providing healthcare that suits patients’ preferences and needs results in improved treatment outcomes.^[3,6-9]

To improve the involvement of patients in the delivery of healthcare, several approaches have been initiated by clinicians over the past years. A new approach termed “partnership in care” seeks to harmonize patients’ preferences and needs, their active participation in clinical decision-making, and the optimization of patients’ capacities for self-care in the provision of healthcare.^[10] The application of the “partnership in care” approach to healthcare delivery entails recognizing patients as members of the healthcare team.

In the past, people were expected to fit in with the routines and practices that health-care services felt were most appropriate. However, with individualized care, health-care services are made less rigid and more flexible to accommodate patients’ preferences in a manner that is most appropriate for them. Such care can be provided to an individual patient on a one-to-one basis, or in groups. However, in both situations, the underlying philosophy is the same, that is working with the patient in the provision of health-care services.^[11]

Research reports suggest that individualized care has the potential to significantly improve the quality of healthcare. These reports indicate that individualized care can positively impact on patients’ health outcomes and improve patients’ confidence and satisfaction with care.^[11-13]

Literature on the impact of individualized care on treatment outcomes in patients living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is insufficient. Two previous studies have reported a positive association between the quality of patient–provider relationship and self-reported adherence to highly active antiretroviral therapy (HAART),^[14,15] which provides strong preliminary evidence that interpersonal aspects of healthcare may directly correlate with the health of patients with HIV. These studies were carried out in countries with advanced health-care systems. Reports of similar studies from developing countries with less advanced health-care systems appear to be lacking. This study was carried out in Nigeria and was aimed at evaluating the quality of individualized care as perceived by patients and its impact on clinical outcomes in persons living with HIV/AIDS.

MATERIALS AND METHODS

RESULTS

Patients’ viral load

The majority of the patients (271) had a documented viral load of <50 copies/mL. A chart showing the categorization of patients based on the viral load is presented in Figure 1.

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Figure 1:

Chart showing patients’ CD4 count.

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Category	Frequency	Percentage
≤200 cells/mm3	43	10.75
>200<500 cells/mm3	119	29.75
>500 cells/mm3	109	27.25
Investigation not done	129	32.25

Patients’ CD4 count

Although we did not find a documented CD4 count in the majority (32.25%) of the cases studied, we found that about 27% (109) of the patients had a documented CD4 count that was >500 cells/mm³.

A chart showing the categorization of patients based on their CD4 count is presented in Figure 2.

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Figure 2:

Chart showing patients’ human immunodeficiency virus viral load.

Export to PPT

Category	Frequency	Percentage
<50 copies/mL	271	67.75
>50<200 copies/mL	39	9.75
>200 copies/mL	45	11.25
Investigation not done	45	11.25

DISCUSSION

The provision of individualized care to patients has been widely viewed as the goal standard for high-quality interpersonal care.^[1,2,18] We assessed the quality of individualized care from the perspective of 400 patients living with HIV/AIDS who received therapeutic care from a tertiary health-care facility in Southern Nigeria. We found as expressed by the majority of the patients that the quality of individualized care provided for patients with HIV/AIDS in the facility was high. Studies have shown that patients who report that their health-care providers demonstrate patient-centered care are generally more satisfied with the care provided and show significant improvements in their health outcomes.^[2,11,22]

Personalized therapeutic care from health-care providers is associated with increased patient satisfaction and improved clinical outcomes in patients with chronic medical conditions.^[11-13] Studies among patients with HIV have also reported that effective patient health-care provider relationship and communication can improve medication adherence.^[23-25]

In the management of HIV/AIDS, strict adherence to HAART is essential to achieve therapeutic goals and prevent drug resistance and disease complications including death.^[12] In general, the aim of the management of HIV/AIDS is to achieve an undetectable viral load and a high CD4 count. We observed that the majority of the population studied had a documented viral load level <50 copies/mL. In the management of HIV, viral load is commonly used to assess the disease progression and outcome of treatment. It is a measure of the number of HIV particles per mL of the patient’s blood. A viral load level of <50 copies/mL can be considered a treatment target by clinicians providing therapeutic care for patients with HIV/AIDS.^[26]

Although we did not find appropriate documentation of CD4 count in the majority of the cases studied, we found that 27% of the study population had a recently documented CD4 count above 500 cells/mm³. CD4 counts >500 cells/mm³ are widely regarded as healthy. The CD4 count plays an essential role in a patient’s immune system and is widely used to assess the strength of a patient’s immune system. Thus, monitoring patients’ CD4 counts is important in the management of HIV/AIDS.

Although not statistically significant, we found a positive correlation between the quality of individualized care and the patients’ CD4 counts and a negative correlation between the quality of individualized care and the patients’ viral load. This finding provides an indication that providing quality personalized care to patients with HIV/AIDS may help improve their CD4 counts and lower their viral load. The association between the quality of individualized care and patients’ viral load and CD4 count as observed in this study may be attributed to a probable improvement in adherence to HAART that is associated with the provision of individualized care to patients with HIV/AIDS. A positive association between patient adherence to HAART and the quality of patient-provider relationship has been reported in previous studies.^[12,27]

Beach et al., in a similar study on HIV patients, observed a significant association between the quality of the patient– provider relationship and having an undetectable serum level of HIV-1 RNA. However, they found that the association was no longer significant after adjusting for patient adherence to HAART, indicating that adherence to HAART was the primary mediator for the association between the quality of patient-provider relationship and suppression of HIV-1 RNA.^[18]

In providing care to patients with long-term conditions such as HIV/AIDS the inclusion of patients’ views, better conversations with the patients, and making clinical decisions based on individual patients’ preferences, needs, and priorities will help keep the burden of treatment on the patients low, and improve patient acceptability and adherence to clinical recommendations.

CONCLUSION

The quality of individualized care offered to patients with HIV/AIDS in the facility as perceived by the majority of the study participants is high. The majority of the patients had HIV-viral load within the treatment target. The provision of individualized care may improve clinical outcomes in patients living with HIV/AIDS. In making therapeutic decisions, particularly for chronic medical conditions, clinicians should take into cognizance patients’ individual social circumstances, preferences, lifestyles, values, and needs.