Decreased awareness of current smoking among health care providers of HIV-positive compared to HIV-negative veterans.
BACKGROUND
Cigarette smoking is an important risk factor for morbidity and mortality in HIV-positive patients on combination antiretroviral therapy.


OBJECTIVE
To determine whether awareness of smoking differs between HIV and non-HIV providers, and to identify factors associated with failure to recognize current smoking.


METHODS
Observational study.


METHODS
801 HIV-positive and 602 HIV-negative patients, 72 HIV and 71 non-HIV providers enrolled in the Veterans Aging Cohort 5 Site Study.


METHODS
Data sources included patient and provider questionnaires; electronic medical records; and the national administrative VA database. We calculated sensitivity, specificity, and measures of agreement between patient- and provider-reported smoking, and examined factors associated with failure to recognize current smoking using logistic regression.


RESULTS
Whereas most providers were correct when they identified a patient as a current smoker (specificity > or = 90%), HIV providers missed current smoking more often (sensitivity 65% for HIV vs. 82% for non-HIV). Kappa scores for current smoking were significantly lower for HIV compared to non-HIV providers (0.55 vs. 0.75, p < .001). In models adjusted for age, gender, race, and other differences, patient HIV status and provider specialty in infectious diseases were independent predictors of a provider's failure to recognize current smoking. Comorbid illnesses, cough/dyspnea, degree of immune competence and HIV viral suppression did not impact recognition of current smoking. Only 39% of HIV providers reported confidence in their ability to influence smoking cessation compared to 62% of non-HIV providers (p = .049).


CONCLUSIONS
Interventions to increase HIV provider awareness of current smoking and skills to influence smoking cessation are needed. Efforts should also target patient populations with smoking-related comorbid diseases who would especially benefit from smoking cessation.
Crothers
Kristina
K
Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Goulet
Joseph L
JL
Rodriguez-Barradas
Maria C
MC
Gibert
Cynthia L
CL
Butt
Adeel A
AA
Braithwaite
R Scott
RS
Peck
Robin
R
Justice
Amy C
AC
D019380:Anti-HIV Agents / Q000627:therapeutic use; D001364:Awareness; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D014728:Veterans
D019380:Anti-HIV Agents