HIV Care Providers'Providers' Role Legitimacy as Supporters of Their Patients' Alcohol Reduction

Abstract

Abstract:Although HIV care providers are strategically situated to support their patients' alcohol reduction efforts, many do not do so, sometimes failing to view this support as consistent with their roles. Using data collected from 112 HIV providers in 7 hospital-based HIV Care Centers in the NYC metropolitan area, this paper examines the correlates of providers' role legitimacy as patients' alcohol reduction supporters. Results indicate that providers (1) responsible for a very large number of patients and (2) with limited confidence in their own ability to give this assistance, but high confidence in their program's ability to do so, were less likely to have a high level of role legitimacy as patients' alcohol reduction supporters. Findings suggest the types of providers to target for alcohol reduction support training.

Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study

“…Provider practices, attitudes, and training regarding provision of alcohol-related care may differ in these clinics from those in general primary care clinics. A previous study of 112 HIV care providers from 7 hospital-based care centers in New York City found that the majority of providers had not received any training regarding alcohol brief intervention and that many providers reported low levels of “role legitimacy” for supporting their patients in reducing their alcohol use (Strauss et al, 2009). In an audiotape study of 434 patients and 45 providers recruited from HIV clinics in four geographically-dispersed U.S. cities, the quality of patient-provider communication was worse for patients with unhealthy alcohol use than those without (Korthuis et al, 2011).…”

“…Since preventive brief interventions are most often provided in primary care, specialty HIV providers might need training in why and how to provide brief interventions (Strauss et al, 2009). Clinicians may be unaware of the effectiveness of brief interventions for reducing alcohol consumption, and the potentially greater impact of repeated brief interventions (Jonas et al, 2012), which could be integrated into HIV care given the frequency of visits.…”

“…While previous studies have suggested gaps in the quality of alcohol-related care provided to PLWH with unhealthy alcohol use (Conigliaro et al, 2003; Korthuis et al, 2011; Metsch et al, 2008; Strauss et al, 2009), they did not compare receipt of alcohol-related care among those with and without HIV. Moreover, they were conducted in small (Chander et al, 2016) and/or recruited (Chander et al, 2016; Conigliaro et al, 2003; Metsch et al, 2008) samples and in settings that had not yet implemented routine alcohol screening and brief intervention.…”

“…Moreover, they were conducted in small (Chander et al, 2016) and/or recruited (Chander et al, 2016; Conigliaro et al, 2003; Metsch et al, 2008) samples and in settings that had not yet implemented routine alcohol screening and brief intervention. However, even in settings with routine implementation of alcohol-related care for unhealthy alcohol use, PLWH may be less likely to receive recommended alcohol-related care than HIV− patients due to the complex care needs of PLWH and/or the possibility that HIV specialty care providers might be less prepared to address unhealthy alcohol use than generalist providers (Strauss et al, 2009). On the other hand, PLWH are recommended to have regular and frequent visits to manage their HIV (The White House, 2013; U.S.…”

Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions

“…Despite its substantial burden on HIV and related illnesses, alcohol use is often overlooked in HIV care (Chander et al., ; Conigliaro et al., ; Korthuis et al., , ; Metsch et al., ; Strauss et al., , ). Research suggests substantial barriers to HIV care providers' addressing alcohol use with their patients (Strauss et al., ,b). Both PLWH and HIV care providers perceive alcohol use as a low priority for HIV clinical care relative to other domains of care (Fredericksen et al., ).…”