Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care

Philip (Todd) Korthuis, David A. Fiellin, Kathleen A. McGinnis, Melissa Skanderson, Amy C. Justice, Adam J. Gordon, Donna Almario Doebler, Steven M. Asch, Lynn E. Fiellin, Kendall Bryant, Cynthia L. Gibert, Stephen Crystal, Matthew Bidwell Goetz, David Rimland, Maria C. Rodriguez-Barradas, Kevin L. Kraemer

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

BACKGROUND: HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. OBJECTIVES: To assess the association between substance use and the quality of HIV care (QOC) received. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: HIV-infected patients enrolled in the Veterans Aging Cohort Study. MEASURES: We collected self-report substance use data and abstracted 9 HIV quality indicators (QIs) from medical records. Independent variables were unhealthy alcohol use (AUDIT-C score ≥4) and illicit drug use (self-report of stimulants, opioids, or injection drug use in past year). Main outcome was the percentage of QIs received, if eligible. We estimated associations between substance use and QOC using multivariable linear regression. RESULTS: The majority of the 3410 patients were male (97.4%) and black (67.0%) with a mean age of 49.1 years (SD = 8.8). Overall, 25.8% reported unhealthy alcohol use, 22% illicit drug use, and participants received 81.5% (SD = 18.9) of QIs. The mean percentage of QIs received was lower for those with unhealthy alcohol use versus not (59.3% vs. 70.0%, P <0.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, P <0.001). In multivariable models, unhealthy alcohol use (adjusted β-2.74; 95% confidence interval:-4.23 to-1.25) and illicit drug use (adjusted β-3.51; 95% CI:-4.99 to-2.02) remained inversely associated with the percentage of QIs received. CONCLUSIONS: Although the overall QOC for these HIV-infected Veteran patients was high, gaps persist for those with unhealthy alcohol and illicit drug use. Interventions that address substance use in HIV-infected patients may improve the QOC received.

Original languageEnglish (US)
Pages (from-to)171-178
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume61
Issue number2
DOIs
StatePublished - Oct 1 2012

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Quality of Health Care
Street Drugs
Alcohols
HIV
Veterans
Self Report
Cohort Studies
Opioid Analgesics
Medical Records
Linear Models
Retrospective Studies
Confidence Intervals
Injections
Health

Keywords

  • alcohol
  • health care
  • HIV
  • opioid-related disorders
  • quality indicators
  • quality of health care

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care. / Korthuis, Philip (Todd); Fiellin, David A.; McGinnis, Kathleen A.; Skanderson, Melissa; Justice, Amy C.; Gordon, Adam J.; Doebler, Donna Almario; Asch, Steven M.; Fiellin, Lynn E.; Bryant, Kendall; Gibert, Cynthia L.; Crystal, Stephen; Goetz, Matthew Bidwell; Rimland, David; Rodriguez-Barradas, Maria C.; Kraemer, Kevin L.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 61, No. 2, 01.10.2012, p. 171-178.

Research output: Contribution to journalArticle

Korthuis, PT, Fiellin, DA, McGinnis, KA, Skanderson, M, Justice, AC, Gordon, AJ, Doebler, DA, Asch, SM, Fiellin, LE, Bryant, K, Gibert, CL, Crystal, S, Goetz, MB, Rimland, D, Rodriguez-Barradas, MC & Kraemer, KL 2012, 'Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care', Journal of Acquired Immune Deficiency Syndromes, vol. 61, no. 2, pp. 171-178. https://doi.org/10.1097/QAI.0b013e31826741aa
Korthuis, Philip (Todd) ; Fiellin, David A. ; McGinnis, Kathleen A. ; Skanderson, Melissa ; Justice, Amy C. ; Gordon, Adam J. ; Doebler, Donna Almario ; Asch, Steven M. ; Fiellin, Lynn E. ; Bryant, Kendall ; Gibert, Cynthia L. ; Crystal, Stephen ; Goetz, Matthew Bidwell ; Rimland, David ; Rodriguez-Barradas, Maria C. ; Kraemer, Kevin L. / Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care. In: Journal of Acquired Immune Deficiency Syndromes. 2012 ; Vol. 61, No. 2. pp. 171-178.
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abstract = "BACKGROUND: HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. OBJECTIVES: To assess the association between substance use and the quality of HIV care (QOC) received. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: HIV-infected patients enrolled in the Veterans Aging Cohort Study. MEASURES: We collected self-report substance use data and abstracted 9 HIV quality indicators (QIs) from medical records. Independent variables were unhealthy alcohol use (AUDIT-C score ≥4) and illicit drug use (self-report of stimulants, opioids, or injection drug use in past year). Main outcome was the percentage of QIs received, if eligible. We estimated associations between substance use and QOC using multivariable linear regression. RESULTS: The majority of the 3410 patients were male (97.4{\%}) and black (67.0{\%}) with a mean age of 49.1 years (SD = 8.8). Overall, 25.8{\%} reported unhealthy alcohol use, 22{\%} illicit drug use, and participants received 81.5{\%} (SD = 18.9) of QIs. The mean percentage of QIs received was lower for those with unhealthy alcohol use versus not (59.3{\%} vs. 70.0{\%}, P <0.001) and those using illicit drugs vs. not (57.8{\%} vs. 70.7{\%}, P <0.001). In multivariable models, unhealthy alcohol use (adjusted β-2.74; 95{\%} confidence interval:-4.23 to-1.25) and illicit drug use (adjusted β-3.51; 95{\%} CI:-4.99 to-2.02) remained inversely associated with the percentage of QIs received. CONCLUSIONS: Although the overall QOC for these HIV-infected Veteran patients was high, gaps persist for those with unhealthy alcohol and illicit drug use. Interventions that address substance use in HIV-infected patients may improve the QOC received.",
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T1 - Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care

AU - Korthuis, Philip (Todd)

AU - Fiellin, David A.

AU - McGinnis, Kathleen A.

AU - Skanderson, Melissa

AU - Justice, Amy C.

AU - Gordon, Adam J.

AU - Doebler, Donna Almario

AU - Asch, Steven M.

AU - Fiellin, Lynn E.

AU - Bryant, Kendall

AU - Gibert, Cynthia L.

AU - Crystal, Stephen

AU - Goetz, Matthew Bidwell

AU - Rimland, David

AU - Rodriguez-Barradas, Maria C.

AU - Kraemer, Kevin L.

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N2 - BACKGROUND: HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. OBJECTIVES: To assess the association between substance use and the quality of HIV care (QOC) received. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: HIV-infected patients enrolled in the Veterans Aging Cohort Study. MEASURES: We collected self-report substance use data and abstracted 9 HIV quality indicators (QIs) from medical records. Independent variables were unhealthy alcohol use (AUDIT-C score ≥4) and illicit drug use (self-report of stimulants, opioids, or injection drug use in past year). Main outcome was the percentage of QIs received, if eligible. We estimated associations between substance use and QOC using multivariable linear regression. RESULTS: The majority of the 3410 patients were male (97.4%) and black (67.0%) with a mean age of 49.1 years (SD = 8.8). Overall, 25.8% reported unhealthy alcohol use, 22% illicit drug use, and participants received 81.5% (SD = 18.9) of QIs. The mean percentage of QIs received was lower for those with unhealthy alcohol use versus not (59.3% vs. 70.0%, P <0.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, P <0.001). In multivariable models, unhealthy alcohol use (adjusted β-2.74; 95% confidence interval:-4.23 to-1.25) and illicit drug use (adjusted β-3.51; 95% CI:-4.99 to-2.02) remained inversely associated with the percentage of QIs received. CONCLUSIONS: Although the overall QOC for these HIV-infected Veteran patients was high, gaps persist for those with unhealthy alcohol and illicit drug use. Interventions that address substance use in HIV-infected patients may improve the QOC received.

AB - BACKGROUND: HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. OBJECTIVES: To assess the association between substance use and the quality of HIV care (QOC) received. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: HIV-infected patients enrolled in the Veterans Aging Cohort Study. MEASURES: We collected self-report substance use data and abstracted 9 HIV quality indicators (QIs) from medical records. Independent variables were unhealthy alcohol use (AUDIT-C score ≥4) and illicit drug use (self-report of stimulants, opioids, or injection drug use in past year). Main outcome was the percentage of QIs received, if eligible. We estimated associations between substance use and QOC using multivariable linear regression. RESULTS: The majority of the 3410 patients were male (97.4%) and black (67.0%) with a mean age of 49.1 years (SD = 8.8). Overall, 25.8% reported unhealthy alcohol use, 22% illicit drug use, and participants received 81.5% (SD = 18.9) of QIs. The mean percentage of QIs received was lower for those with unhealthy alcohol use versus not (59.3% vs. 70.0%, P <0.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, P <0.001). In multivariable models, unhealthy alcohol use (adjusted β-2.74; 95% confidence interval:-4.23 to-1.25) and illicit drug use (adjusted β-3.51; 95% CI:-4.99 to-2.02) remained inversely associated with the percentage of QIs received. CONCLUSIONS: Although the overall QOC for these HIV-infected Veteran patients was high, gaps persist for those with unhealthy alcohol and illicit drug use. Interventions that address substance use in HIV-infected patients may improve the QOC received.

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