Decreased Awareness of Current Smoking Among Health Care Providers of HIV-positive Compared to HIV-negative Veterans
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Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.
To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors associated with failure to recognize current smoking.
801 HIV-positive and 602 HIV-negative patients, 72 HIV and 71 non-HIV providers enrolled in the Veterans Aging Cohort 5 Site Study.
Data sources included patient and provider questionnaires; electronic medical records; and the national administrative VA database. We calculated sensitivity, specificity, and measures of agreement between patient- and provider-reported smoking, and examined factors associated with failure to recognize current smoking using logistic regression.
Whereas most providers were correct when they identified a patient as a current smoker (specificity ≥90%), HIV providers missed current smoking more often (sensitivity 65% for HIV vs. 82% for non-HIV). Kappa scores for current smoking were significantly lower for HIV compared to non-HIV providers (0.55 vs. 0.75, p < .001). In models adjusted for age, gender, race, and other differences, patient HIV status and provider specialty in infectious diseases were independent predictors of a provider’s failure to recognize current smoking. Comorbid illnesses, cough/dyspnea, degree of immune competence and HIV viral suppression did not impact recognition of current smoking. Only 39% of HIV providers reported confidence in their ability to influence smoking cessation compared to 62% of non-HIV providers (p = .049).
Interventions to increase HIV provider awareness of current smoking and skills to influence smoking cessation are needed. Efforts should also target patient populations with smoking-related comorbid diseases who would especially benefit from smoking cessation.
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- Decreased Awareness of Current Smoking Among Health Care Providers of HIV-positive Compared to HIV-negative Veterans
Journal of General Internal Medicine
Volume 22, Issue 6 , pp 749-754
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- detection of smoking
- smoking cessation
- Industry Sectors
- Author Affiliations
- 1. Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- 2. VA Connecticut Healthcare System, West Haven, and General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- 3. Medical Service, Infectious Diseases, Michael A. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, TX, USA
- 4. Medical Service, Infectious Diseases, VA Medical Center, and George Washington University, Washington, DC, USA
- 5. Infectious Diseases, Department of Internal Medicine, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA