title: Patient-Provider Engagement and Chronic Pain in Drug-Using, Primarily African American Persons Living with HIV/AIDS.
abstract: Among disadvantaged persons living with HIV/AIDS (PLHIV), patient-provider engagement, which has been defined as patient-provider relationships that promote the use of health care services and are characterized by active listening and supportive decision making, has been associated with antiretroviral therapy (ART) maintenance and viral suppression. However, chronic pain, depression, and substance use, all of which are prevalent in this population, can reduce the quality of patient-provider engagement. We hypothesized a model in which chronic pain, depression, and substance use would be associated with poorer patient-provider engagement, which would be positively associated with adherence, with the latter associated positively with viral suppression. We analyzed data from the BEACON study, which included surveys from 383 PLHIV who were primarily African American, on ART, and had histories of drug use. Due to six missing cases on the chronic pain variable, we used data from 377 respondents in a structural equation model. Chronic pain and depressive symptoms were significantly associated with poorer patient-provider engagement, while substance use was associated with better engagement. Patient-provider engagement in turn was associated with better ART adherence, which was associated with higher viral suppression. Results suggest the role of chronic pain in poor patient-physician engagement in this population, which has potential implications for quality of HIV patient care and health outcomes. Findings suggest the need for attention to patient-provider engagement in PLHIV.
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA. mmitch32@jhu.edu.
authors: Mary M
authors: MM
authors: Mitchell
authors: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Trang Q
authors: TQ
authors: Nguyen
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA.
authors: Allysha C
authors: AC
authors: Maragh-Bass
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA.
authors: Sarina R
authors: SR
authors: Isenberg
authors: Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Mary Catherine
authors: MC
authors: Beach
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 745, Baltimore, MD, 21205, USA.
authors: Amy R
authors: AR
authors: Knowlton
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D059350:Chronic Pain / Q000150:complications* / Q000628:therapy; D003863:Depression / Q000208:ethnology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D019966:Substance-Related Disorders / Q000150:complications* / Q000208:ethnology; D011795:Surveys and Questionnaires
keywords: Chronic pain; Depressive symptoms; HIV/AIDS; Patient-provider engagement; Substance use