Emily C Williams1, Gwen T Lapham2, Susan M Shortreed3, Anna D Rubinsky4, Jennifer F Bobb5, Kara M Bensley6, Sheryl L Catz7, Julie E Richards8, Katharine A Bradley9. 1. Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: emily.williams3@va.gov. 2. Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. 3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Department of Biostatistics, University of Washington, Seattle, WA, United States. 4. Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States. 5. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. 6. Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States. 7. Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, United States. 8. Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. 9. Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE) Veterans Affairs (VA) Puget Sound Health Care System - Seattle Division, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Abstract
BACKGROUND: Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV- patients. METHODS: Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C≥5) documented in their medical records 10/2009-5/2013 were eligible. Primary and secondary outcomes were brief intervention documented ≤14days after a positive alcohol screen, and a composite measure of any alcohol-related care (brief intervention, specialty addictions treatment or pharmacotherapy documented ≤365 days), respectively. Unadjusted and adjusted regression analyses compared alcohol-related care outcomes in PLWH and HIV- patients. RESULTS: The sample included 830,825 outpatients (3,514 PLWH), reflecting 1,172,606 positive screens (1-5 per patient). For PLWH, 57.0% (95% confidence interval 55.4-58.5%) of positive screens were followed by brief intervention, compared to 73.8% (73.7-73.9%) for HIV- patients [relative rate: 0.77 (0.75-0.79), p<0.001]. After adjustment, comparable proportions were 61.0% (59.3-62.6%) for PLWH and 73.7% (73.6-73.8%) for HIV- patients [adjusted RR=0.83 (0.80-0.85); p<0.001]. Secondary outcome results were similar: for PLWH and HIV- patients, 67.1% (65.7-68.6%) and 77.7% (95% CI 77.7-77.8%) of positive screens, respectively, were followed by any alcohol-related care after adjustment [adjusted RR=0.86 (0.85-0.88), p<0.001]. CONCLUSIONS: In this large national sample of VA outpatients with unhealthy alcohol use, PLWH were less likely to receive alcohol-related care than HIV- patients. Special efforts may be needed to ensure alcohol-related care reaches PLWH. Published by Elsevier B.V.
BACKGROUND:Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV- patients. METHODS: Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C≥5) documented in their medical records 10/2009-5/2013 were eligible. Primary and secondary outcomes were brief intervention documented ≤14days after a positive alcohol screen, and a composite measure of any alcohol-related care (brief intervention, specialty addictions treatment or pharmacotherapy documented ≤365 days), respectively. Unadjusted and adjusted regression analyses compared alcohol-related care outcomes in PLWH and HIV- patients. RESULTS: The sample included 830,825 outpatients (3,514 PLWH), reflecting 1,172,606 positive screens (1-5 per patient). For PLWH, 57.0% (95% confidence interval 55.4-58.5%) of positive screens were followed by brief intervention, compared to 73.8% (73.7-73.9%) for HIV- patients [relative rate: 0.77 (0.75-0.79), p<0.001]. After adjustment, comparable proportions were 61.0% (59.3-62.6%) for PLWH and 73.7% (73.6-73.8%) for HIV- patients [adjusted RR=0.83 (0.80-0.85); p<0.001]. Secondary outcome results were similar: for PLWH and HIV- patients, 67.1% (65.7-68.6%) and 77.7% (95% CI 77.7-77.8%) of positive screens, respectively, were followed by any alcohol-related care after adjustment [adjusted RR=0.86 (0.85-0.88), p<0.001]. CONCLUSIONS: In this large national sample of VA outpatients with unhealthy alcohol use, PLWH were less likely to receive alcohol-related care than HIV- patients. Special efforts may be needed to ensure alcohol-related care reaches PLWH. Published by Elsevier B.V.
Entities:
Keywords:
Alcohol; Alcohol use disorders; Brief intervention; Disparities; HIV
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