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). Dr Ray’s time was supported through a T32 predoctoral fellowship from the Agency for Healthcare Research and Quality (AHRQ 1T32 HS017582). Dr Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). Dr Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05), Dr Saha was supported by the Department of Veterans Affairs, and both Drs Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards.
Substance abuse -- Patients -- Counseling of, Substance abuse -- Psychological aspects, Physician and patient, Patients -- Attitudes -- Surveys
BACKGROUND AND OBJECTIVES: Substance use is a prevalent issue in primary care with wide-reaching implications, particularly for the care of HIV-infected patients. This analysis identified patient and provider characteristics associated with high comfort discussing substance use in HIV primary care clinics using multivariable logistic regression.
METHODS: A total of 413 patients and 44 providers completed surveys on their comfort discussing substance use. Additional independent variables from surveys included demographics, drug and alcohol use, self-efficacy, and activation for patients. Providerlevel data included demographics, training, practice descriptors, and stress levels.
RESULTS: The majority of patients (76%) and providers (73%) reported high comfort. In multivariable analysis, patients with current problematic alcohol use or current drug use were half as likely to report high comfort compared to their non-substance-using peers. Higher patient self-efficacy and high levels of patient activation were independently associated with increased odds of high patient comfort. While provider-level characteristics were not associated with provider comfort, the types of patients a provider saw were. Namely, the proportion of patients on antiretroviral therapy was inversely associated with the odds of high provider comfort, whereas the proportion of patients with high patient activation was positively associated.
CONCLUSIONS: Patients likely to benefit from a discussion of substance use, those with current use, are the least likely to report comfort discussing that use. Interventions that increase patient activation or self-efficacy may also increase their comfort. This research guides future interventions to increase the prevalence of discussions on substance use.
Ray, Moira K., Mary Catherine Beach, Christina Nicolaidis, Dongseok Choi, Somnath Saha, and P. Todd Korthuis. "Patient and provider comfort discussing substance use." Family medicine 45, no. 2 (2013): 109.