Communications between patients with HIV and their providers differ along racial and substance use lines
Research Activities, January 2012, No. 377
Two new studies reveal that communications between patients with HIV and their providers differ along racial and substance-use lines. This is important, given that significant racial disparities exist in HIV care in the United States and that more than half of Americans infected with HIV report a history of substance use.
The first study found that providers were more verbally dominant in conversations with black than white patients. The second study revealed that, while it appears there is healthy patient-provider communication with illicit drug users, patients with unhealthy alcohol use are less satisfied with their provider encounters. Both studies, supported by the Agency for Healthcare Research and Quality (Contract No. 190-01-0012 and grant HS13903) are briefly summarized here.
Beach, M.C., Saha, S., Korthuis P.T., and others (2011). "Patient-provider communication differs for black compared to white HIV-infected patients." AIDS Behavior 15, pp. 805-811.
This study found providers to be more verbally dominant with their black patients than their white patients. In other words, providers expressed more complete thoughts (utterances) than the patient did and blacks provided less information to their providers than whites during clinic visits. However, there was no association between visit length and the patient's race.
The researchers audio recorded patient care visits at four HIV outpatient care sites in Baltimore, Detroit, New York, and Portland. A total of 45 providers, including physicians, nurse practitioners, and physician assistants, agreed to participate in the study. The final sample of patients included 246 blacks and 100 whites. Recordings were analyzed using a coding system that categorizes utterances into question-asking, counseling, and socio-emotional communication. Overall, the patients who participated in the study were satisfied with the care they received at these clinics. The amount and quality of patient and provider socio-emotional communication was similar for blacks and whites. However, because blacks spoke less during their clinic visits, the researchers recommend that providers make an extra effort to engage and involve blacks with HIV more during the medical encounter.
Korthius, P.T., Saha, S., Chander, G., and others (2011). "Substance use and the quality of patient-provider communication in HIV clinics." AIDS Behavior 15, pp. 832-841.
This study found that providers spent less time talking with patients who reported either current or past unhealthy alcohol use. In addition, they used fewer patient-engagement and activating statements and fewer counseling statements on lifestyle or psychosocial behaviors to patients reporting current unhealthy drinking patterns compared with patients who were not problem drinkers. In turn, these patients made fewer engaging, activating, and positive statements to their providers. Patients without a history of unhealthy drinking had clinic visits that averaged around 4 minutes longer and received more patient-engagement and activating statements during their visit with providers. With illicit drug users, providers were more likely to make negative statements and ask more questions during encounters compared with patients without a history of illicit drug use. These drug users also made more negative statements. However, more counseling and lifestyle statements were exchanged during these medical visits than with visits with problem drinkers. Problem drinkers rated the quality of provider-patient communication lower than patients without unhealthy alcohol use. On the other hand, there was no difference in the ratings of provider-patient communication between illicit drug users and non-users of illicit drugs.
The study used the same 45 providers who participated in the first study. Among the patient participants, 39 were current unhealthy alcohol users, 198 past users, and 170 who never had unhealthy alcohol use. The study also included 113 current illicit drug users, 203 former users, and 97 who never used these drugs. As in the other study, clinic encounters were audiotaped and analyzed using the same method. According to the researchers, the communication patterns between providers and unhealthy drinkers with HIV infection suggest a higher risk for poor HIV-related outcomes. Even as patients' levels of depression increased, they were still less likely to receive psychosocial or counseling statements from their providers. The researchers suggest that more resources, time, and interventions need to be in place so that care can be improved for patients with unhealthy alcohol use and HIV.