Substance Use and the Quality of Patient-Provider Communication in HIV Clinics

Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR 97239-3098, USA.
AIDS and Behavior (Impact Factor: 3.49). 05/2011; 15(4):832-41. DOI: 10.1007/s10461-010-9779-8
Source: PubMed


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.

Download full-text


Available from: Dennis Mccarty, Sep 29, 2015
19 Reads
  • Source
    • "We analyzed data gathered by the enhancing communication and HIV outcomes (ECHO) study [24] [25] [26] [27] [28], a cross-sectional observational study of patient–provider communication. Recruitment for the ECHO study is described in detail elsewhere [24]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Motivational interviewing (MI) can promote behavior change, but HIV care providers rarely have training in MI. Little is known about the use of MI-consistent behavior among untrained providers. This study examines the prevalence of such behaviors and their association with patient intentions to reduce high-risk sexual behavior. METHODS: Audio-recorded visits between HIV-infected patients and their healthcare providers were searched for counseling dialog regarding sexual behavior. The association of providers' MI-consistence with patients' statements about behavior change was assessed. RESULTS: Of 417 total encounters, 27 met inclusion criteria. The odds of patient commitment to change were higher when providers used more reflections (p=0.017), used more MI consistent utterances (p=0.044), demonstrated more empathy (p=0.049), and spent more time discussing sexual behavior (p=0.023). Patients gave more statements in favor of change (change talk) when providers used more reflections (p<0.001) and more empathy (p<0.001), even after adjusting for length of relevant dialog. CONCLUSION: Untrained HIV providers do not consistently use MI techniques when counseling patients about sexual risk reduction. However, when they do, their patients are more likely to express intentions to reduce sexual risk behavior. PRACTICE IMPLICATIONS: MI holds promise as one strategy to reduce transmission of HIV and other sexually transmitted infections.
    Patient Education and Counseling 05/2013; 93(1). DOI:10.1016/j.pec.2013.04.001 · 2.20 Impact Factor
  • Source
    • "The Enhancing Communication and HIV Outcomes (ECHO) Study was designed to assess racial/ethnic disparities in the patient-provider relationship in HIV care [33] [34] [35], and how communication and relationships impact patient experiences and outcomes [32,36–38]. Subjects were HIV care providers, including physicians, nurse practitioners and physician assistants; and their patients at four HIV outpatient care sites in separate regions of the United States. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. METHODS: Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads - the problems or issues addressed; and processes within threads - basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. RESULTS: 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. CONCLUSIONS: In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. Practice implications: Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
    Patient Education and Counseling 02/2013; 91(2). DOI:10.1016/j.pec.2012.12.012 · 2.20 Impact Factor
  • Source
    • "Expansion of access to buprenorphine in general medical systems could extend agonist therapy to many untreated opioid-dependent persons who either do not have access to a methadone clinic or who do not want the burden of daily medication visits. In addition, expanding access may improve the quality of care for opioid-dependent individuals, because physicians in general medical settings may identify and manage co-occurring health consequences of opioid dependence as part of monitoring the agonist pharmacotherapy [9,10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems. The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences. Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002). Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.
    Clinical Medicine &amp Research 08/2012; 10(3):170. DOI:10.3121/cmr.2012.1100.ca7-04
Show more