Influence of patient trust in provider and health literacy on receipt of guideline-concordant chronic opioid therapy in HIV care settings
Keywords:HIV, opioids, health literacy, patient trust, guideline-concordant care
Objective: Persons with HIV (PWH) frequently receive opioids for pain. Health literacy and trust in provider may impact patient–provider communication, and thus receipt of guideline-concordant opioid monitoring. We analyzed baseline data of HIV-positive patients on chronic opioid therapy (COT) in a trial to improve guideline-concordant COT in HIV clinics.
Design: Retrospective cohort study.
Setting: Two hospital-based safety-net HIV clinics in Boston and Atlanta.
Patients and participants: A cohort of patients who were ≥18 years, HIV-positive, had received ≥ 3 opioid prescriptions from a study site ≥21 days apart within a 6-month period during the prior year and had ≥1 visit at the HIV clinic in the prior 18 months.
Main outcome measures: Adjusted logistic regression models examined whether health literacy and trust in provider (scale scored 11-55, higher indicates more trust) were associated with: (1) ≥ 2 urine drug tests (UDTs) and (2) presence of an opioid treatment agreement.
Results: Among 166 PWH, mean trust in provider was 47.4 (SD 6.6); 117 (70 percent) had adequate health literacy. Fifty patients (30 percent) had ≥ 2 UDTs and 20 (12 percent) had a treatment agreement. The adjusted odds ratio (aOR) for a one-point increase in trust in provider was 0.97 for having ≥ 2 UDTs (95 percent CI 0.92-1.02) and 1.03 for opioid treatment agreement (95 percent CI 0.95-1.12). The aOR for adequate health literacy was 0.89 for having ≥ 2 UDTs (95 percent CI 0.42-1.88) and 1.66 for an opioid treatment agreement (95 percent CI 0.52-5.31).
Conclusions: Health literacy and trust in provider were not associated with chronic opioid therapy quality outcomes.
Merlin JS, Cen L, Praestgaard A, et al.: Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. J Pain Symptom Manage. 2012; 43(3): 638-645. DOI: https://doi.org/10.1016/j.jpainsymman.2011.04.019
Miaskowski C, Penko JM, Guzman D, et al.: Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain. 2011; 12(9): 1004-1016. DOI: https://doi.org/10.1016/j.jpain.2011.04.002
Rudd RA, Aleshire N, Zibbell JE, et al.: Increases in drug and opioid overdose deaths–United States. MMWR. 2016; 64(50-51): 2000-2014. DOI: https://doi.org/10.15585/mmwr.mm6450a3
Hasegawa K, Espinola JA, Brown DF, et al.: Trends in US emergency department visits for opioid overdose, 1993-2010. Pain Med. 2014; 15(10): 1765-1770. DOI: https://doi.org/10.1111/pme.12461
Okie S: A flood of opioids, a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981-1985. DOI: https://doi.org/10.1056/NEJMp1011512
Coben JH, Davis SM, Furbee PM, et al.: Hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers. Am J Prev Med. 2010; 38(5): 517-524. DOI: https://doi.org/10.1016/j.amepre.2010.01.022
Calcaterra S, Glanz J, Binswanger IA: National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013; 131(3): 263-270. DOI: https://doi.org/10.1016/j.drugalcdep.2012.11.018
Edelman EJ, Gordon K, Becker WC, et al.: Receipt of opioid analgesics by HIV-infected and uninfected patients. J Gen Intern Med. 2013; 28(1): 82-90. DOI: https://doi.org/10.1007/s11606-012-2189-z
Flores J, Liang Y, Ketchum NS, et al.: Prescription opioid use is associated with virologic failure in people living with HIV. AIDS Behav. 2018; 22(4): 1323-1328. DOI: https://doi.org/10.1007/s10461-017-1842-2
Lemons A, DeGroote N, Peréz A, et al.: Opioid misuse among HIV-positive adults in medical care: Results from the medical monitoring project, 2009-2014. J Acquir Immune Def Syndr. 2019; 80(2): 127-134. DOI: https://doi.org/10.1097/QAI.0000000000001889
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(No. RR-1): 1-49. DOI: https://doi.org/10.15585/mmwr.rr6501e1
Bruce RD, Merlin J, Lum PJ, et al.: 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV. Clin Infect Dis. 2017; 65(10): e1-e37. DOI: https://doi.org/10.1093/cid/cix636
Isenberg SR, Maragh-Bass AC, Ridgeway K, et al.: A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders. J Opioid Manag. 2017; 13(1): 5-16. DOI: https://doi.org/10.5055/jom.2017.0363
Kroenke K, Alford DP, Argoff C, et al.: Challenges with implementing the centers for disease control and prevention opioid guideline: A consensus panel report. Pain Med. 2019; 20(4): 724-735. DOI: https://doi.org/10.1093/pm/pny307
Kertesz SG, Manhapra A: The drive to taper opioids: Mind the evidence, and the ethics. Spinal Cord Ser Cases. 2018; 4: 64. DOI: https://doi.org/10.1038/s41394-018-0092-5
Husain JM, LaRochelle M, Keosaian J, et al.: Reasons for opioid discontinuation and unintended consequences following opioid discontinuation within the TOPCARE trial. Pain Med. 2019; 20(7): 1330-1337. DOI: https://doi.org/10.1093/pm/pny124
Dawson-Rose C, Cuca YP, Webel AR, et al.: Building trust and relationships between patients and providers: An essential complement to health literacy in HIV care. J Assoc Nurses AIDS Care. 2016; 27(5): 574-584. DOI: https://doi.org/10.1016/j.jana.2016.03.001
Pellowski JA, Kalichman SC, Matthews KA, et al.: A pandemic of the poor: Social disadvantage and the US HIV epidemic. Am Psychol. 2013; 68(4): 197-209. DOI: https://doi.org/10.1037/a0032694
Centers for Disease Control and Prevention: HIV in the United States by Region. 2018. Available at https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html. Accessed January 31, 2020.
De Santis JP, Florom-Smith A, Vermeesch A, et al.: Motivation, management, and mastery: A theory of resilience in the context of HIV infection. J Am Psychiatr Nurses Assoc. 2013; 19(1): 36-46. DOI: https://doi.org/10.1177/1078390312474096
Herek GM, Capitanio JP, Widaman KF: HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991-1999. Am J Public Health. 2002; 92(3): 371-377. DOI: https://doi.org/10.2105/AJPH.92.3.371
Link BG, Phelan J: Social conditions as fundamental causes of disease. J Health Soc Behav. 1995; 35: 80-94. DOI: https://doi.org/10.2307/2626958
Krieger N: Discrimination and health inequities. Int J Health Serv. 2014; 44(4): 643-710. DOI: https://doi.org/10.2190/HS.44.4.b
Buchman DZ, Ho A, Illes J: You present like a drug addict: Patient and clinician perspectives on trust and trustworthiness in chronic pain management. Pain Med. 2016; 17(8): 1394-1406. DOI: https://doi.org/10.1093/pm/pnv083
Frank JW, Levy C, Matlock DD, et al.: Patients’ perspectives on tapering of chronic opioid therapy: A qualitative study. Pain Med. 2016; 17(10): 1838-1847. DOI: https://doi.org/10.1093/pm/pnw078
Harle CA, Bauer SE, Hoang HQ, et al.: Decision support for chronic pain care: How do primary care physicians decide when to prescribe opioids? A qualitative study. BMC Fam Pract. 2015; 16: 48. DOI: https://doi.org/10.1186/s12875-015-0264-3
Kennedy LC, Binswanger IA, Mueller SR, et al.: Those conversations in “My experience don’t go well”: A qualitative study of primary care provider experiences tapering long-term opioid medications. Pain Med. 2018; 19(11): 2201-2211. DOI: https://doi.org/10.1093/pm/pnx276
Buchman DZ, Ho A: What’s trust got to do with it? Revisiting opioid contracts. J Med Ethics. 2014; 40(10): 673-677. DOI: https://doi.org/10.1136/medethics-2013-101320
Samet JH, Tsui JI, Cheng DM, et al.: Improving the delivery of chronic opioid therapy among people living with HIV: A cluster randomized clinical trial. Clin Infect Dis. 2020. DOI: 10.1093/cid/ciaa1025. DOI: https://doi.org/10.1093/cid/ciaa1025
Lira MC, Tsui JI, Liebschutz JM, et al.: Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study—A cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV. HIV Res Clin Practice. 2019; 20(2): 48-63. DOI: https://doi.org/10.1080/15284336.2019.1627509
Anderson LA, Dedrick RF: Development of the trust in physician scale: A measure to assess interpersonal trust in patient– physician relationships. Psychol Rep. 1990; 67(3 Pt 2): 1091-1100. DOI: https://doi.org/10.2466/pr0.1990.67.3f.1091
Thom DH, Ribisl KM, Stewart AL, et al.: Further validation and reliability testing of the trust in physician scale. The Stanford trust study physicians. Med Care. 1999; 37(5): 510-517. DOI: https://doi.org/10.1097/00005650-199905000-00010
Wallace LS, Rogers ES, Roskos SE, et al.: Brief report: Screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006; 21(8): 874-877. DOI: https://doi.org/10.1111/j.1525-1497.2006.00532.x
Chew LD, Griffin JM, Partin MR, et al.: Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008; 23(5): 561-566. DOI: https://doi.org/10.1007/s11606-008-0520-5
Chew LD, Bradley KA, Boyko EJ: Brief questions to identify patients with inadequate health literacy. Fam Med. 2004; 36(8): 588-594.
Boulware LE, Cooper LA, Ratner LE, et al.: Race and trust in the health care system. Public Health Rep. 2003; 118(4): 358-365. DOI: https://doi.org/10.1016/S0033-3549(04)50262-5
Halbert CH, Armstrong K, Gandy OH, Jr, et al.: Racial differences in trust in health care providers. Arch Intern Med. 2006; 166(8): 896-901. DOI: https://doi.org/10.1001/archinte.166.8.896
Bennett IM, Chen J, Soroui JS, et al.: The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009; 7(3): 204-211. DOI: https://doi.org/10.1370/afm.940
Bonds DE, Foley KL, Dugan E, et al.: An exploration of patients’ trust in physicians in training. J Health Care Poor Underserved. 2004; 15(2): 294-306. DOI: https://doi.org/10.1353/hpu.2004.0018
Tanco K, Rhondali W, Park M, et al.: Predictors of trust in the medical profession among cancer patients receiving palliative care: A preliminary study. J Palliat Med. 2016; 19(9): 991-994. DOI: https://doi.org/10.1089/jpm.2016.0089
Rikard RV, Thompson MS, McKinney J, et al.: Examining health literacy disparities in the United States: A third look at the national assessment of adult literacy (NAAL). BMC Public Health. 2016; 16(1): 975-975. DOI: https://doi.org/10.1186/s12889-016-3621-9
Kutner M, Greenburg E, Jin Y, et al. The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. National Center for Education Statistics Retrieved. 2006. Available at https://filesericedgov/fulltext/ED493284pdf. Accessed January 30, 2020.
Lacey RJ, Campbell P, Lewis M, et al.: The impact of inadequate health literacy in a population with musculoskeletal pain. Health Literacy Res Practice. 2018; 2(4): e215-e220. DOI: https://doi.org/10.3928/24748307-20181101-01
Lobo CP, Pfalzgraf AR, Giannetti V, et al.: Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients. Prim Care Companion CNS Disord. 2014; 16(5). DOI: 10.4088/PCC.14m01664. DOI: https://doi.org/10.4088/PCC.14m01664
Cleeland CS, Ryan KM: Pain assessment: Global use of the brief pain inventory. Ann Acad Med Singap. 1994; 23(2): 129-138.
Tsui JI, Walley AY, Cheng DM, et al.: Provider opioid prescribing practices and the belief that opioids keep people living with HIV engaged in care: A cross-sectional study. AIDS Care. 2019; 31(9): 1140-1144. DOI: https://doi.org/10.1080/09540121.2019.1566591
American Psychological Association: HIV/AIDS & Socioeconomic Status. Available at https://www.apa.org/pi/ses/resources/publications/factsheet-hiv-aids.pdf. Accessed January 30, 2020.
Sereda Y, Kiriazova T, Makarenko O, et al.: Stigma and quality of co-located care for HIV-positive people in addiction treatment in Ukraine: A cross-sectional study. J Intern AIDS Soc. 2020; 23(5): e25492. DOI: https://doi.org/10.1002/jia2.25492
Nyblade L, Stockton MA, Giger K, et al.: Stigma in health facilities: Why it matters and how we can change it. BMC Med. 2019; 17(1): 25. DOI: https://doi.org/10.1186/s12916-019-1256-2
Oliva EM, Bowe T, Manhapra A, et al.: Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: Observational evaluation. BMJ. 2020; 368: M283. DOI: https://doi.org/10.1136/bmj.m283
Demidenko MI, Dobscha SK, Morasco BJ, et al.: Suicidal ideation and suicidal self-directed violence following clinician-initiated prescription opioid discontinuation among long-term opioid users. Gen Hosp Psychiatry. 2017; 47: 29-35. DOI: https://doi.org/10.1016/j.genhosppsych.2017.04.011
Mark TL, Parish W: Opioid medication discontinuation and risk of adverse opioid-related health care events. J Subst Abuse Treat. 2019; 103: 58-63. DOI: https://doi.org/10.1016/j.jsat.2019.05.001
James JR, Scott JM, Klein JW, et al.: Mortality after discontinuation of primary care-based chronic opioid therapy for pain: A retrospective cohort study. J Gen Intern Med. 2019; 34(12): 2749-2755. DOI: https://doi.org/10.1007/s11606-019-05301-2
Kertesz SG, Gordon AJ: A crisis of opioids and the limits of prescription control: United States. Addiction. 2019; 114(1): 169-180. DOI: https://doi.org/10.1111/add.14394
Scherer M, Weiss L, Kamler A, et al.: Patient recommendations for opioid prescribing in the context of HIV care: Findings from a set of public deliberations. AIDS Care. 2020; 32: 1471-1478. DOI: https://doi.org/10.1080/09540121.2019.1705962
Centers for Disease Control and Prevention: Wide-Ranging Online Data for Epidemiologic Research (WONDER), Multiple-Cause-of-Death File, 2000–2014. Atlanta, GA: Centers for Disease Control and Prevention, 2015. Available at http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf. Accessed June 14, 2018.
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