Patient–provider rapport in the health care of people who inject drugs

Abstract

Little research has described determinants and consequences of patient–provider rapport among people who inject drugs (PWIDs). This mixed-method study (a) qualitatively described facilitators, barriers, and consequences to rapport development between PWIDs and their health care providers and (b) quantitatively tested the hypothesis that quality of rapport is associated with positive patterns of service use. Two exploratory focus groups with PWIDs and care providers were conducted. Subsequently, 89 PWIDs completed a survey interview; of those, eight completed a follow-up qualitative interview. Qualitative results indicated that rapport is influenced by drug-related behaviors, addiction severity, provider expertise, patient-centered care, and perceived discrimination and that rapport then influences patient compliance, timing of care, and criminal activity. Quantitative results indicated that rapport predicted PWID satisfaction with care as well as frequency and timing of emergency department presentations. Results suggest that PWID–provider rapport has several unique determinants and is associated with positive health care outcomes.