Substance Use and the Quality of Patient-Provider Communication in HIV Clinics
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The objective of this study was to estimate the influence of substance use on the quality of patient-provider communication during HIV clinic encounters. Patients were surveyed about unhealthy alcohol and illicit drug use and rated provider communication quality. Audio-recorded encounters were coded for specific communication behaviors. Patients with vs. without unhealthy alcohol use rated the quality of their provider’s communication lower; illicit drug user ratings were comparable to non-users. Visit length was shorter, with fewer activating/engaging and psychosocial counseling statements for those with vs. without unhealthy alcohol use. Providers and patients exhibited favorable communication behaviors in encounters with illicit drug users vs. non-users, demonstrating greater evidence of patient-provider engagement. The quality of patient-provider communication was worse for HIV-infected patients with unhealthy alcohol use but similar or better for illicit drug users compared with non-users. Interventions should be developed that encourage providers to actively engage patients with unhealthy alcohol use.
KeywordsAlcoholism Substance-related disorders Communication HIV Quality of health care Patient satisfaction
Each author contributed to this study as follows: P. Todd Korthuis (design, data collection, analysis, writing), Somnath Saha (design, analysis, writing), Geetanjali Chander (design, analysis, writing), Dennis McCarty (analysis, writing), Richard D. Moore (design, data collection, analysis, writing), Jonathan A. Cohn (design, data collection, writing), Victoria L. Sharp (design, data collection, writing), Mary Catherine Beach (design, data collection, analysis, writing). The authors thank Ms. Sarann Bielavitz for assistance with manuscript preparation. This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012), and an award from the Lawrence S. Linn Trust. Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). Dr. Chander’s time was supported by the National Institute on Alcohol Abuse & Alcoholism (K23AA015313). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05) and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. Dr. Moore is supported by the NIH (K24 DA000432, R01 DA11602, R01 AA16893, U01 AI069918).
The views expressed in this paper are those of the authors. No official endorsement by DHHS, AHRQ, the National Institutes of Health, or NIDA is intended or should be inferred.
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