The physician-patient working alliance and patient psychological attachment, adherence, outcome expectations, and satisfaction in a sample of rheumatology patients.

Over the past twenty years, the physician-patient relationship (eg, the physician-patient working alliance) has emerged as an integral component to the treatment of patients for a myriad of health conditions. Psychological, emotional, and behavioral dimensions of patients' working alliance with their physicians, along with patients' attachment styles, were examined in relation to rheumatology patients' adherence to treatment plans, outcome expectations, and satisfaction. Study participants were 101 adult outpatients from a rheumatology clinic. Path analyses demonstrated that the physician-patient working alliance predicted outcome expectations (Standardized Beta [SB] = 0.27), and patient satisfaction (SB = 0.62), and that patient satisfaction in turn predicted patient adherence (SB = 0.48). Physicians' ratings of patient adherence were significantly and positively correlated with patients' ratings of the physician-patient working alliance. No significant paths were evident with respect to patient attachment. The physician-patient working alliance directly predicts patient satisfaction, and outcome expectations, and indirectly predicts adherence through patient satisfaction.