title: Patient and provider comfort discussing substance use.
abstract: OBJECTIVE
  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. Provider-level 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.
authors: Department of Family Medicine, and Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97239, USA. raymo@ohsu.edu
authors: Moira K
authors: MK
authors: Ray
authors: Mary Catherine
authors: MC
authors: Beach
authors: Christina
authors: C
authors: Nicolaidis
authors: Dongseok
authors: D
authors: Choi
authors: Somnath
authors: S
authors: Saha
authors: P Todd
authors: PT
authors: Korthuis
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D003142:Communication; D005260:Female; D015658:HIV Infections; D006679:HIV Seropositivity; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires
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