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.

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    • "In order to achieve the benefits of reduced morbidity and mortality, strict medication adherence is required [20]. The context of HIV care can offer unique challenges, complicated by patients' perceived stigma and discrimination, barriers to trust, healthcare disparities, and comorbidities of mental health and substance use [21] [22] [23]. Effective patient–clinician relationships appear to help patients overcome these challenges and achieve positive outcomes. "
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    ABSTRACT: Objective: We examined associations of clinicians' empathy with patient-clinician communication behaviors, patients' rating of care, and medication self-efficacy. Methods: We analyzed 435 adult patients and 45 clinicians at four outpatient HIV care sites in the United States. Negative binomial regressions investigated associations between clinician empathy and patient-clinician communication, assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions investigated associations between clinician empathy and patient ratings of clinician communication, overall satisfaction, and medication self-efficacy. Results: Clinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk (IRR 0.79, p<0.05), while clinicians in the middle vs. lowest engaged in more positive talk (IRR 1.31, p<0.05), more questions (IRR 1.42, p<0.05), and more patient activating talk (IRR 1.43, p<0.05). Patients of higher empathy clinicians disclosed more psychosocial and biomedical information. Patients of clinicians in both the middle and highest (vs. lowest) empathy tertiles had greater odds of reporting highest medication self-efficacy (OR 1.80, 95% CI 1.16-2.80; OR 2.13, 95% CI 1.37-3.32). Conclusions: Clinician empathy may be expressed through addressing patient engagement in care, by fostering cognitive, rather than primarily emotional, processing. Practice implications: Clinicians should consider enhancing their own empathic capacity, which may encourage patients' self-efficacy in medication adherence.
    Patient Education and Counseling 09/2015; DOI:10.1016/j.pec.2015.09.001 · 2.20 Impact Factor
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    • "These findings have not been replicated until now. Furthermore , clinician respect for patients may be particularly relevant in HIV care due to several factors such as racial/ethnic differences between patients and clinicians [12] [13] [14] [15] [16] [17] [18] [19], HIV-related stigma [20– 22], and stigma towards substance use disorders [23] [24] [25]. Patients with active substance abuse perceive less respect from clinicians and demonstrate less engagement in HIV care [10]. "
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    ABSTRACT: Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters. We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes. When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)]. Respect is associated with positive and patient-centered communication behaviors during encounters. Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees' respect in communication skills training. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Patient Education and Counseling 08/2015; DOI:10.1016/j.pec.2015.08.020 · 2.20 Impact Factor
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    • "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]. "
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    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
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