Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

Wynne Callon, Mary Catherine Beach, Somnath (Som) Saha, Geetanjali Chander, Ira B. Wilson, Michael Barton Laws, Victoria Sharp, Jonathan Cohn, Richard Moore, Philip (Todd) Korthuis

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p <0.001), and ‘leading’ questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - May 19 2016

Fingerprint

Disclosure
HIV
Cocaine
Heroin
Pharmaceutical Preparations
Drinking
Alcohols
Interviews

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Assessing Problematic Substance Use in HIV Care : Which Questions Elicit Accurate Patient Disclosures? / Callon, Wynne; Beach, Mary Catherine; Saha, Somnath (Som); Chander, Geetanjali; Wilson, Ira B.; Laws, Michael Barton; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Korthuis, Philip (Todd).

In: Journal of General Internal Medicine, 19.05.2016, p. 1-7.

Research output: Contribution to journalArticle

Callon, Wynne ; Beach, Mary Catherine ; Saha, Somnath (Som) ; Chander, Geetanjali ; Wilson, Ira B. ; Laws, Michael Barton ; Sharp, Victoria ; Cohn, Jonathan ; Moore, Richard ; Korthuis, Philip (Todd). / Assessing Problematic Substance Use in HIV Care : Which Questions Elicit Accurate Patient Disclosures?. In: Journal of General Internal Medicine. 2016 ; pp. 1-7.
@article{05df9972d6524dab87acea3dde262a07,
title = "Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?",
abstract = "BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 {\%}) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 {\%}) patients disclosed and 22 (29 {\%}) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 {\%} of open-ended and normalizing questions, 58 {\%} of closed-ended questions, and 22 {\%} of leading questions. After adjusting for drug type, closed-ended questions were 41 {\%} less likely (p <0.001), and ‘leading’ questions 78 {\%} less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.",
author = "Wynne Callon and Beach, {Mary Catherine} and Saha, {Somnath (Som)} and Geetanjali Chander and Wilson, {Ira B.} and Laws, {Michael Barton} and Victoria Sharp and Jonathan Cohn and Richard Moore and Korthuis, {Philip (Todd)}",
year = "2016",
month = "5",
day = "19",
doi = "10.1007/s11606-016-3733-z",
language = "English (US)",
pages = "1--7",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Assessing Problematic Substance Use in HIV Care

T2 - Which Questions Elicit Accurate Patient Disclosures?

AU - Callon, Wynne

AU - Beach, Mary Catherine

AU - Saha, Somnath (Som)

AU - Chander, Geetanjali

AU - Wilson, Ira B.

AU - Laws, Michael Barton

AU - Sharp, Victoria

AU - Cohn, Jonathan

AU - Moore, Richard

AU - Korthuis, Philip (Todd)

PY - 2016/5/19

Y1 - 2016/5/19

N2 - BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p <0.001), and ‘leading’ questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.

AB - BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p <0.001), and ‘leading’ questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.

UR - http://www.scopus.com/inward/record.url?scp=84969857236&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84969857236&partnerID=8YFLogxK

U2 - 10.1007/s11606-016-3733-z

DO - 10.1007/s11606-016-3733-z

M3 - Article

C2 - 27197974

AN - SCOPUS:84969857236

SP - 1

EP - 7

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -