Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  PubMed  CAS  Google Scholar 

  2. Korthuis PT, Josephs JS, Fleishman JA, et al. Substance abuse treatment in human immunodeficiency virus: the role of patient-provider discussions. J Subst Abuse Treat. 2008;35(3):294–303.

    Article  PubMed  Google Scholar 

  3. Andersen RM, Bozzette SA, Shapiro MF, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS consortium. HIV cost and services Utilization Study. Health Serv Res. 2000;35(2):389–416.

    PubMed  CAS  Google Scholar 

  4. Gebo KA, Fleishman JA, Conviser R, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr. 2005;38(1):96–103.

    Article  PubMed  Google Scholar 

  5. Mathews WC, McCutchan JA, Asch SM, et al. National estimates of HIV-related symptom prevalence from the HIV cost and services utilization study. Med Care. 2000;38(7):750–62.

    Article  PubMed  CAS  Google Scholar 

  6. Fleishman JA, Gebo KA, Reilly ED, et al. Hospital and outpatient health services utilization among HIV-infected adults in care 2000–2002. Med Care. 2005;43(9 Suppl):III40–52.

    PubMed  Google Scholar 

  7. Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med. 2003;18(4):248–57.

    Article  PubMed  Google Scholar 

  8. Turner BJ, Laine C, Yang CP, Hauck WW. Effects of long-term, medically supervised, drug-free treatment and methadone maintenance treatment on drug users’ emergency department use and hospitalization. Clin Infect Dis. 2003;37(5):15.

    Article  Google Scholar 

  9. Messeri PA, Abramson DM, Aidala AA, Lee F, Lee G. The impact of ancillary HIV services on engagement in medical care in New York City. AIDS Care. 2002;14(1):15–29.

    Article  Google Scholar 

  10. Burnam MA, Bing EG, Morton SC, et al. Use of mental health and substance abuse treatment services among adults with HIV in the United States. Arch Gen Psychiatry. 2001;58(8):729–36.

    Article  PubMed  CAS  Google Scholar 

  11. Palepu A, Raj A, Horton NJ, et al. Substance abuse treatment and risk behaviors among HIV-infected persons with alcohol problems. J Subst Abuse Treat. 2005;28(1):3–9.

    Article  PubMed  Google Scholar 

  12. Palepu A, Tyndall MW, Joy R, et al. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend. 2006;84(2):188–94.

    Article  PubMed  Google Scholar 

  13. Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. Health Psychol. 1994;13(5):384–92.

    Article  PubMed  CAS  Google Scholar 

  14. Beach MC, Saha S, Korthuis PT, et al. Differences in patient-provider communication for Hispanic compared to non-Hispanic White patients in HIV care. J Gen Intern Med. 2010;25(7):682–7.

    Article  PubMed  Google Scholar 

  15. Beach MC, Saha S, Korthuis PT, et al. Patient-provider communication differs for Black compared to White HIV-infected patients. Aids Behav. 2010 (E-published ahead of print).

  16. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.

    Article  PubMed  Google Scholar 

  17. Hall JA, Roter DL, Milburn MA, Daltroy LH. Patients’ health as a predictor of physician and patient behavior in medical visits. A synthesis of four studies. Med Care. 1996;34(12):1205–18.

    Article  PubMed  CAS  Google Scholar 

  18. Roter DL. The outpatient medical encounter and elderly patients. Clin Geriatr Med. 2000;16(1):95–107.

    Article  PubMed  CAS  Google Scholar 

  19. Epstein AM, Taylor WC, Seage GR III. Effects of patients’ socioeconomic status and physicians’ training and practice on patient-doctor communication. Am J Med. 1985;78(1):101–6.

    Article  PubMed  CAS  Google Scholar 

  20. O’Connor PG, Samet JH. Substance abuse: the expanding role of general internal medicine. J Gen Intern Med. 2002;17(5):398–9.

    PubMed  Google Scholar 

  21. Friedmann PD, Lemon SC, Stein MD, Etheridge RM, D’Aunno TA. Linkage to medical services in the drug abuse treatment outcome study. Med Care. 2001;39(3):284–95.

    Article  PubMed  CAS  Google Scholar 

  22. Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA. 1998;279(15):1227–31.

    Article  PubMed  CAS  Google Scholar 

  23. Yamada T, Chen C-C, Yamada T. Economic evaluation of relapse prevention for substance users: treatment settings and health care policy. Adv Health Econ Health Serv Res. 2005;16:431–50.

    Article  PubMed  Google Scholar 

  24. Bakken S, Holzemer WL, Brown MA, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. Aids Patient Care STDS. 2000;14(4):189–97.

    Article  PubMed  CAS  Google Scholar 

  25. Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med. 2004;19(11):1096–103.

    Article  PubMed  Google Scholar 

  26. Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.

    Article  PubMed  Google Scholar 

  27. Gebo KA, Moore RD, Fleishman JA. The HIV research network: a unique opportunity for real time clinical utilization analysis in HIV. Hopkins HIV Rep. 2003;15(6):5–6.

    PubMed  Google Scholar 

  28. Cacciola JS, Alterman AI, McLellan A, Lin Y-T, Lynch KG. Initial evidence for the reliability and validity of a “Lite” version of the addiction severity index. Drug Alcohol Depend. 2007;87(2–3):297–302.

    Article  PubMed  Google Scholar 

  29. Kosten TR, Rounsaville BJ, Kleber HD. Concurrent validity of the addiction severity index. J Nerv Ment Dis. 1983;171(10):606–10.

    Article  PubMed  CAS  Google Scholar 

  30. McLellan AT, Luborsky L, Cacciola J, et al. New data from the addiction severity index. Reliability and validity in three centers. J Nerv Ment Dis. 1985;173(7):412–23.

    Article  PubMed  CAS  Google Scholar 

  31. Stoffelmayr BE, Mavis BE, Kasim RM. The longitudinal stability of the addiction severity index. J Subst Abuse Treat. 1994;11(4):373–8.

    Article  PubMed  CAS  Google Scholar 

  32. Hodgins DC, el-Guebaly N. More data on the addiction severity index. Reliability and validity with the mentally ill substance abuser. J Nerv Ment Dis. 1992;180(3):197–201.

    Article  PubMed  CAS  Google Scholar 

  33. Joyner LM, Wright JD, Devine JA. Reliability and validity of the addiction severity index among homeless substance misusers. Subst Use Misuse. 1996;31(6):729–51.

    Article  PubMed  CAS  Google Scholar 

  34. Brown LS Jr, Alterman AI, Rutherford MJ, Cacciola JS, Zaballero AR. Addiction severity index scores of four racial/ethnic and gender groups of methadone maintenance patients. J Subst Abuse. 1993;5(3):269–79.

    Article  PubMed  Google Scholar 

  35. Roter D. Roter interaction analysis manual. Baltimore, MD: Johns Hopkins University Bloomberg School of Public Health; 1999.

    Google Scholar 

  36. Roter D, Larson S. The roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. Patient Educ Couns. 2002;46(4):243–51. (see comment).

    Article  PubMed  Google Scholar 

  37. Roter DL, Hall JA, Katz NR. Relations between physicians’ behaviors and analogue patients’ satisfaction, recall, and impressions. Med Care. 1987;25(5):437–51.

    Article  PubMed  CAS  Google Scholar 

  38. Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77(3):305–39.

    Article  PubMed  CAS  Google Scholar 

  39. Wilson IB, Ding L, Hays RD, et al. HIV patients’ experiences with inpatient and outpatient care: results of a national survey. Med Care. 2002;40(12):1149–60.

    Article  PubMed  Google Scholar 

  40. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.

    PubMed  CAS  Google Scholar 

  41. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  42. Phin J. Nonpatient polydrug users. In: Wesson D, Carlin A, Adams K, Beschner G, editors. Polydrug abuse: the results of a national collaborative study. New York, NY: Academic Press; 1978. p. 31–57.

    Google Scholar 

  43. Turner BJ, Fleishman JA, Wenger N, et al. Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. J Gen Intern Med. 2001;16(9):625–33.

    Article  PubMed  CAS  Google Scholar 

  44. White-Means S, Zhiyong D, Hufstader M, Brown LT. Cultural competency, race, and skin tone bias among pharmacy, nursing, and medical students: implications for addressing health disparities. Med Care Res Rev. 2009;66(4):436–55.

    Article  PubMed  Google Scholar 

  45. Schwartz MB, Chambliss HON, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11(9):1033–9.

    Article  PubMed  Google Scholar 

  46. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26.

    Article  PubMed  Google Scholar 

  47. Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–63.

    Article  PubMed  Google Scholar 

  48. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 Suppl):S110–27. (erratum appears in Med Care 1989;27(7):679).

    Article  PubMed  CAS  Google Scholar 

  49. Pringle M, Stewart-Evans C. Does awareness of being video recorded affect doctors’ consultation behaviour? Br J Gen Pract. 1990;40(340):455–8.

    PubMed  CAS  Google Scholar 

  50. Wolraich ML, Albanese M, Stone G, et al. Medical communication behavior system. An interactional analysis system for medical interactions. Med Care. 1986;24(10):891–903.

    Article  PubMed  CAS  Google Scholar 

  51. McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients. The addiction severity index. J Nerv Ment Dis. 1980;168(1):26–33.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

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).

Disclaimer

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.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-475, Portland, OR, 97239-3098, USA

    P. Todd Korthuis & Somnath Saha

  2. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA

    P. Todd Korthuis, Somnath Saha & Dennis McCarty

  3. Section of General Internal Medicine, Portland VA Medical Center, Portland, OR, USA

    Somnath Saha

  4. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Geetanjali Chander, Richard D. Moore & Mary Catherine Beach

  5. Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA

    Jonathan A. Cohn

  6. Center for Comprehensive Care, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA

    Victoria L. Sharp

Authors
  1. P. Todd Korthuis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Somnath Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geetanjali Chander
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dennis McCarty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard D. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jonathan A. Cohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victoria L. Sharp
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mary Catherine Beach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Todd Korthuis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Korthuis, P.T., Saha, S., Chander, G. et al. Substance Use and the Quality of Patient-Provider Communication in HIV Clinics. AIDS Behav 15, 832–841 (2011). https://doi.org/10.1007/s10461-010-9779-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9779-8

Keywords

Search

Navigation