A nurse is talking with a client who has to come to the clinic for HIV testing

Learn more about how to incorporate brief conversations into your practice by topic area.

Studies have found that low trust in providers and poor patient-provider relationships have been associated with lower retention in care and lower satisfaction with the clinic experience.1-3 These findings underscore the need to build supportive relationships with patients that improve their health outcomes. Here are some ways health care providers and their practices can achieve this:

• Communicate with the patient nonjudgmentally to learn what they know about the importance of retention.
• Identify skills that the patient might lack to remain in care, such as problem-solving skills.
• Guide the patient to identify possible changes that would eliminate or reduce barriers they face; congratulate patient when they are able lessen the barriers.
• Strategize with the patient to identify new goals and healthy behaviors.
• Actively refer patients to relevant clinic support services as needed to provide additional support for retention.

• Be direct, nonjudgmental, and supportive.
• Use open-ended questions to involve the patient in decision making regarding their HIV treatment and overall care.

• Educate patients about their options and ask what questions come to mind when considering those options to encourage informed conversation as part of the decision making process.
• Encourage discussions on subjects about substance use, sexual behavior, and mental health.
• Provide referrals when appropriate, and assess patient willingness to complete the referral.*

• When possible, extend office hours or offer more flexible appointment times one or more days per week (e.g., offer some walk-in or same-day appointments).
• Maintain accurate patient contact information and update it at every visit.
• Use patient-tracking systems to determine whether a patient has dropped out of care; contact patients promptly to reschedule missed appointments.
• Help patients find resources to address unmet needs and barriers to care. When possible, connect patients with childcare, transportation, or other services and offer collocation of primary care and social services.*
• When warranted, encourage patients to access substance use or mental health services.
• Encourage patients to identify friends and family who can help with encouragement, support, and attend medical appointments with them.

* Patient navigators, case managers, peer counselors, social workers, and treatment advocates can also assist with referrals and resources.

Talking with patients at each visit allows health care providers to reinforce positive behaviors, uncover barriers to successful long-term treatment, and facilitate access to services and resources as needs change over time. Below are some suggestions to help start the conversation:

• “I know it can be difficult to keep all your appointments, but it’s very important. What can we do to make sure you keep your next appointment?”
• “People with HIV do better overall when they come to their appointments on a regular basis. How can we work together to help you stay as healthy as possible?”
• “It’s been a while since you last came in. Let’s talk about what has been keeping you from coming to see me.”

1. Flickinger TE, Saha S, Moore RD, Beach MC. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr. Jul 01 2013;63(3):362-366. PubMed abstractexternal icon.
2. Dang BN, Westbrook RA, Hartman CM, Giordano TP. Retaining HIV patients in care: the role of initial patient care experiences. AIDS Behav. Oct 2016;20(10):2477-2487. PubMed abstractexternal icon.
3. Magnus M, Herwehe J, Murtaza-Rossini M, et al. Linking and retaining HIV patients in care: the importance of provider attitudes and behaviors. AIDS Patient Care STDS. May 2013;27(5):297-303. PubMed abstractexternal icon.