Unhealthy Alcohol and Illicit Drug Use Are Associated With Decreased Quality of HIV Care

HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. To assess the association between substance use and the quality of HIV care (QOC) received. Retrospective cohort study. HIV-infected patients enrolled in the Veterans Aging Cohort...

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Veröffentlicht in:	Journal of acquired immune deficiency syndromes (1999) 2012-10, Vol.61 (2), p.171-178
Hauptverfasser:	KORTHUIS, P. Todd, FIELLIN, David A, GIBERT, Cynthia L, CRYSTAL, Stephen, BIDWELL GOETZ, Matthew, RIMLAND, David, RODRIGUEZ-BARRADAS, Maria C, KRAEMER, Kevin L, MCGINNIS, Kathleen A, SKANDERSON, Melissa, JUSTICE, Amy C, GORDON, Adam J, ALMARIO DOEBLER, Donna, ASCH, Steven M, FIELLIN, Lynn E, BRYANT, Kendall
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Schlagworte:	Adult Alcohols - adverse effects Biological and medical sciences Clinical outcomes Cohort Studies Drug use Female Fundamental and applied biological sciences. Psychology HIV HIV Infections - complications HIV Infections - therapy Human immunodeficiency virus Human viral diseases Humans Infectious diseases Male Medical sciences Microbiology Middle Aged Miscellaneous Multivariate analysis Patients Quality of care Quality of Health Care - statistics & numerical data Retrospective Studies Street Drugs - adverse effects Substance-Related Disorders - epidemiology Veterans Viral diseases Virology
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container_title	Journal of acquired immune deficiency syndromes (1999)
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creator	KORTHUIS, P. Todd FIELLIN, David A GIBERT, Cynthia L CRYSTAL, Stephen BIDWELL GOETZ, Matthew RIMLAND, David RODRIGUEZ-BARRADAS, Maria C KRAEMER, Kevin L MCGINNIS, Kathleen A SKANDERSON, Melissa JUSTICE, Amy C GORDON, Adam J ALMARIO DOEBLER, Donna ASCH, Steven M FIELLIN, Lynn E BRYANT, Kendall
description	HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. To assess the association between substance use and the quality of HIV care (QOC) received. Retrospective cohort study. HIV-infected patients enrolled in the Veterans Aging Cohort Study. 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. 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. 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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Todd ; FIELLIN, David A ; GIBERT, Cynthia L ; CRYSTAL, Stephen ; BIDWELL GOETZ, Matthew ; RIMLAND, David ; RODRIGUEZ-BARRADAS, Maria C ; KRAEMER, Kevin L ; MCGINNIS, Kathleen A ; SKANDERSON, Melissa ; JUSTICE, Amy C ; GORDON, Adam J ; ALMARIO DOEBLER, Donna ; ASCH, Steven M ; FIELLIN, Lynn E ; BRYANT, Kendall</creator><creatorcontrib>KORTHUIS, P. Todd ; FIELLIN, David A ; GIBERT, Cynthia L ; CRYSTAL, Stephen ; BIDWELL GOETZ, Matthew ; RIMLAND, David ; RODRIGUEZ-BARRADAS, Maria C ; KRAEMER, Kevin L ; MCGINNIS, Kathleen A ; SKANDERSON, Melissa ; JUSTICE, Amy C ; GORDON, Adam J ; ALMARIO DOEBLER, Donna ; ASCH, Steven M ; FIELLIN, Lynn E ; BRYANT, Kendall</creatorcontrib><description>HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. To assess the association between substance use and the quality of HIV care (QOC) received. Retrospective cohort study. HIV-infected patients enrolled in the Veterans Aging Cohort Study. 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Psychology ; HIV ; HIV Infections - complications ; HIV Infections - therapy ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infectious diseases ; Male ; Medical sciences ; Microbiology ; Middle Aged ; Miscellaneous ; Multivariate analysis ; Patients ; Quality of care ; Quality of Health Care - statistics & numerical data ; Retrospective Studies ; Street Drugs - adverse effects ; Substance-Related Disorders - epidemiology ; Veterans ; Viral diseases ; Virology</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2012-10, Vol.61 (2), p.171-178</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Oct 1, 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c550t-2946d0f478c59739cbbae954ceb4f745762bbe03eff62c3ce6165b4f6fae969f3</citedby><cites>FETCH-LOGICAL-c550t-2946d0f478c59739cbbae954ceb4f745762bbe03eff62c3ce6165b4f6fae969f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26403117$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22820808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KORTHUIS, P. Todd</creatorcontrib><creatorcontrib>FIELLIN, David A</creatorcontrib><creatorcontrib>GIBERT, Cynthia L</creatorcontrib><creatorcontrib>CRYSTAL, Stephen</creatorcontrib><creatorcontrib>BIDWELL GOETZ, Matthew</creatorcontrib><creatorcontrib>RIMLAND, David</creatorcontrib><creatorcontrib>RODRIGUEZ-BARRADAS, Maria C</creatorcontrib><creatorcontrib>KRAEMER, Kevin L</creatorcontrib><creatorcontrib>MCGINNIS, Kathleen A</creatorcontrib><creatorcontrib>SKANDERSON, Melissa</creatorcontrib><creatorcontrib>JUSTICE, Amy C</creatorcontrib><creatorcontrib>GORDON, Adam J</creatorcontrib><creatorcontrib>ALMARIO DOEBLER, Donna</creatorcontrib><creatorcontrib>ASCH, Steven M</creatorcontrib><creatorcontrib>FIELLIN, Lynn E</creatorcontrib><creatorcontrib>BRYANT, Kendall</creatorcontrib><title>Unhealthy Alcohol and Illicit Drug Use Are Associated With Decreased Quality of HIV Care</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. To assess the association between substance use and the quality of HIV care (QOC) received. Retrospective cohort study. HIV-infected patients enrolled in the Veterans Aging Cohort Study. 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. 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. 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.</description><subject>Adult</subject><subject>Alcohols - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Drug use</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. 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subjects	Adult Alcohols - adverse effects Biological and medical sciences Clinical outcomes Cohort Studies Drug use Female Fundamental and applied biological sciences. Psychology HIV HIV Infections - complications HIV Infections - therapy Human immunodeficiency virus Human viral diseases Humans Infectious diseases Male Medical sciences Microbiology Middle Aged Miscellaneous Multivariate analysis Patients Quality of care Quality of Health Care - statistics & numerical data Retrospective Studies Street Drugs - adverse effects Substance-Related Disorders - epidemiology Veterans Viral diseases Virology
title	Unhealthy Alcohol and Illicit Drug Use Are Associated With Decreased Quality of HIV Care
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