HIV primary care providers--Screening, knowledge, attitudes and behaviors related to alcohol interventions

Geetanjali Chander; Anne K Monroe; Heidi M Crane; Heidi E Hutton; Michael S Saag; Karen Cropsey; Joseph J Eron; E Byrd Quinlivan; Elvin Geng; William Christopher Mathews; Stephen Boswell; Benigno Rodriquez; Megan Ellison; Mari M Kitahata; Richard D Moore; Mary E McCaul

doi:10.1016/j.drugalcdep.2016.01.015

HIV primary care providers--Screening, knowledge, attitudes and behaviors related to alcohol interventions

Drug Alcohol Depend. 2016 Apr 1:161:59-66. doi: 10.1016/j.drugalcdep.2016.01.015. Epub 2016 Jan 29.

Authors

Geetanjali Chander¹, Anne K Monroe², Heidi M Crane³, Heidi E Hutton⁴, Michael S Saag⁵, Karen Cropsey⁶, Joseph J Eron⁷, E Byrd Quinlivan⁸, Elvin Geng⁹, William Christopher Mathews¹⁰, Stephen Boswell¹¹, Benigno Rodriquez¹², Megan Ellison¹³, Mari M Kitahata¹⁴, Richard D Moore¹⁵, Mary E McCaul¹⁶

Affiliations

¹ Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: Gchande1@jhmi.edu.
² Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: amonroe4@jhmi.edu.
³ Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States. Electronic address: hcrane@uw.edu.
⁴ Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: hhutton@jhmi.edu.
⁵ Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL. 1720 7th Ave S., Birmingham, AL 35294-0017, United States. Electronic address: msaag@uab.edu.
⁶ Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 7th Ave S., Birmingham, AL 35294-0017, United States. Electronic address: kcropsey@uab.edu.
⁷ Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States. Electronic address: joseph_eron@med.unc.edu.
⁸ Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States. Electronic address: ebq@med.unc.edu.
⁹ Department of Medicine, University of California at San Francisco, 1001 Potrero Ave, SFGH 80, San Francisco, CA 94110, United States. Electronic address: genge@php.ucsf.edu.
¹⁰ Department of Medicine, University of California San Diego, 200 W Arbor Dr # 140, San Diego, CA 92103, United States. Electronic address: cmathews@ucsd.edu.
¹¹ Department of Medicine, Harvard University School of Medicine, Mass Fenway Community Health Ctr, 1340 Boylston St, Boston, MA 02215, United States. Electronic address: sboswell@fenwayhealth.org.
¹² Department of Medicine-Infectious Diseases, Case Western Reserve University, 111000 Euclid Ave, Cleveland, OH 44106, United States.
¹³ Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: Ellison@jhmi.edu.
¹⁴ Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States. Electronic address: kitahata@uw.edu.
¹⁵ Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: rdmoore@jhmi.edu.
¹⁶ Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: mmccaul1@jhmi.edu.

Abstract

Background: Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown.

Methods: We conducted a cross-sectional survey of HIV providers from 8 HIV clinical sites across the United States. Surveys queried knowledge and use of alcohol screening, brief advice, counseling and pharmacotherapy, confidence and willingness to prescribe pharmacotherapy and barriers to their use of alcohol pharmacotherapy. We used multivariable logistic regression to examine provider factors associated with confidence and willingness to prescribe pharmacotherapy.

Results: Providers (N=158) were predominantly female (58%) and Caucasian (73%); almost half were infectious disease physicians and 31% had been in practice 10-20 years. Most providers (95%) reported always or usually screening for alcohol use, although only 10% reported using a formal screening tool. Over two-thirds never or rarely treated alcohol-dependent patients with pharmacotherapy themselves. Most (71%) referred alcohol-dependent patients for treatment. Knowledge regarding alcohol pharmacotherapy was low. The major barrier to prescribing pharmacotherapy was insufficient training on use of pharmacotherapy. Provider confidence ratings were positively correlated with their practice patterns.

Conclusions: HIV providers reported high rates of screening for alcohol use, though few used a formal screening tool. Most providers referred alcohol dependent patients to outside resources for treatment. Few reported prescribing alcohol pharmacotherapy. Increased training on alcohol pharmacotherapy may increase confidence in prescribing and use of these medications in HIV care settings.

Keywords: Alcohol screening; Confidence; Education; HIV; Knowledge.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Alcohol Drinking / therapy*
Counseling
Cross-Sectional Studies
Female
HIV Infections / therapy
Health Knowledge, Attitudes, Practice*
Health Personnel / psychology*
Humans
Male
Middle Aged
Primary Health Care*
Surveys and Questionnaires
United States

Abstract

Publication types

MeSH terms

Grants and funding