Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey.
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SUBMITTER: Shuter J
PROVIDER: S-EPMC3275677 | biostudies-literature | 2012 Feb
REPOSITORIES: biostudies-literature
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Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey.
Shuter Jonathan J Salmo Lauren N LN Shuter Avishai D AD Nivasch Esther C EC Fazzari Melissa M Moadel Alyson B AB
AIDS and behavior 20120201 2
The entire online HIV Medical Association US registry was invited to complete a questionnaire regarding beliefs and practices related to smoking in persons living with HIV/AIDS (PLWHAs). 363/486 returned completed questionnaires. Respondents from 43 states reported caring for 76,570 PLWHAs. Only 22.9% had ever received formal tobacco treatment training. Respondents generally agreed that smoking is an important issue in PLWHAs, but reported low levels of cessation-promoting activities. Providers ...[more]
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Project description:INTRODUCTION:Breach of confidentiality or invasion of privacy from the collection and use of medical records, particularly those of patients with HIV/AIDS or other diseases sensitive to stigmatization, should be prevented by all related stakeholders in healthcare settings. The main focus of this study was to assess practices regarding security and confidentiality of HIV-related information among staff at HIV outpatient clinics (HIV-OPCs) in Vietnam. METHODS:A descriptive cross-sectional study was conducted at all 312 HIV-OPCs across the country using an online survey technique. RESULTS:In general, the staff practices for securing and protecting patient information were at acceptable levels. Most staff had proper measures and practices for maintaining data security; however, the protection of patient confidentiality, particularly for data access, sharing, and transfer still required improvement. Most HIV-OPC staff had good or moderate knowledge and positive perceptions towards security and confidentiality issues. Staff who were not trained in the practice of security measures differed significantly from those who were trained (OR: 3.74; 95%CI: 1.44-9.67); staff needing improved knowledge levels differed significantly from those with good (OR: 5.20; 95%CI: 2.39-11.32) and moderate knowledge levels (OR: 5.10; 95%CI: 2.36-11.00); and staff needing improved perception levels differed significantly from those with good (i.e., with 100% proper practices) and moderate perception levels (OR: 5.67; 95%CI: 2.93-10.95). Staff who were not trained in the protection of data confidentiality differed significantly from those who were trained (OR: 2.18; 95%CI: 1.29-3.65). CONCLUSIONS:Training is an important factor to help raise the levels of proper practices regarding confidentiality and security, to improve knowledge and raise awareness about change among staff. The operation and management of HIV treatment and care in Vietnam are currently transitioning from separate healthcare clinics (HIV-OPC) into units integrated into general hospitals/healthcare facilities. The findings of this study highlight topics that could be used for improving management and operation of information system and revising guidelines and regulations on protection measures/strategies for data security and confidentiality of HIV/AIDS patients by Vietnam health authorities or other countries facing similar situations. Secure infrastructure and secure measures for data access and use are very important, worthwhile investments. The provision of continuous training and active enforcement and monitoring of the practices of healthcare personnel might lead to an improved understanding and acknowledegement of the importance of national policies/guidelines regarding HIV-related patient information.
| S-EPMC5685590 | biostudies-literature
Project description:BackgroundTobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.ObjectivesTo assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions.Search methodsWe searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases.Selection criteriaControlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA.Data collection and analysisTwo review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria.Main resultsWe identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study.Authors' conclusionsThere is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
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Project description:BackgroundUp till today, studies carried in Lebanon have focused more on the prevalence of HIV and behaviors and quality of life of infected individuals, however, none of these studies discussed the degree of stigma towards these populations. Therefore, the aim of this study is to measure the rate of stigma in terms of knowledge, attitude and practice towards patients living with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) and examine the factors associated with this stigma.MethodsA cross-sectional survey, enrolling 862 participants, was carried across the five governorates in Lebanon: Beirut, Mount Lebanon, North, South and Bekaa. The survey was a self-administered questionnaire which covered information about participants' general demographics, their knowledge, attitudes, practices and awareness towards HIV/AIDS in Lebanon., attitudes towards PLWHA, practices related to HIV/AIDS and awareness regarding HIV/AIDS situation in Lebanon.ResultsThe response rate to the survey was 78.36% (862 participants). Being Muslim (Beta = -2.56) or Druze (Beta = -2.64) compared to Christians were significantly associated with lower knowledge towards HIV/AIDS, whereas having a secondary (Beta = 2.71) and a university (Beta = 3.04) levels of education compared to illiteracy and higher age (Beta = 0.05) were significantly associated with higher knowledge. Higher knowledge (Beta = 0.66) was significantly associated with better attitude, whereas higher age (Beta = -0.14) and being Muslim compared to Christian (Beta = -3.44) were significantly associated with worse attitude. Better attitude (Beta = 0.02) was significantly associated with better practice, whereas females compared to males (Beta = -0.39), having a secondary level of education compared to illiteracy (Beta = -0.88) and being Muslim compared to Christian (Beta = -0.32) were significantly associated with worse practice.ConclusionOur results stress the need for educational programs, advocacy campaigns and policies to help reduce HIV stigma. This will then help start developing interventions and strategies for a possible reduction in the stigmatization level.
| S-EPMC7993853 | biostudies-literature
Project description:BackgroundHealth care providers' (HCP) advice on tobacco prevention and cessation is critical in addressing the tobacco use epidemic among adolescents. However, examination of whether receiving advice from HCPs differs by adolescent sociodemographic characteristics and tobacco use is limited.MethodsHCP advice to abstain from using tobacco was examined using the 2020 National Youth Tobacco Survey (N = 12,483). Sociodemographic (age, sex, sexual orientation, race/ethnicity, and region) and tobacco use (non-current, sole, dual/poly) differences by HCP advice were evaluated using adjusted logistic regression models.ResultsAmong the sample, 37.26% of adolescents received HCP advice to abstain from using tobacco products, and 31.35% received HCP advice to abstain from using e-cigarettes specifically. Adolescents who were non-Hispanic Black (vs. non-Hispanic White) were more likely not to receive HCP advice to abstain from all tobacco products (OR = 1.31, 95% CI: 1.08-1.59). Adolescents who were non-Hispanic Black (vs. non-Hispanic White) (OR = 1.41, 95% CI: 1.16-1.73) or sexual minority (vs. heterosexual) (OR = 1.16, 95% CI: 1.02-1.33) were more likely not to receive HCP advice to abstain from e-cigarettes. Adolescents who were aged 16-18 (vs. aged 9-12) (OR = 0.68, 95% CI: 0.56-0.83) or currently use dual/poly tobacco products (vs. adolescents who do not currently use tobacco) (OR = 0.56, 95% CI: 0.43-0.74) were more likely to receive HCP advice to abstain from using e-cigarettes).ConclusionsMany U.S. adolescents do not receive HCP advice to abstain from using tobacco. HCPs should increase tobacco prevention and cessation advice across adolescent groups, particularly racial/ethnic and sexual minorities. HCP training and public health policies that improve delivery of e-cigarette advice to adolescents are essential.
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Project description:ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials.
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Project description:BACKGROUND:Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS:To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique. The survey was administered to a convenience sample of ED providers attending the 2016 American College of Emergency Physicians Scientific Assembly in Las Vegas. RESULTS:Surveys were completed by 409 emergency medicine providers from 46 states and 7 countries with a wide range of years of experience and primary practice environment (academic versus community centers). Respondents estimated that 30% of patients presenting to the ED with chest pain thought to be low risk for ACS have anxiety or panic as the primary cause but they directly communicate this belief to only 42% of these patients and provide discharge instructions to 48%. Only 39% of respondents reported adequate hospital resources to ensure follow-up. Community-based providers reported more adequate follow-up for these patients than their academic center colleagues (46% vs. 34%; p = 0.015). Most providers (82%) indicated that they wanted to have referral resources available to a specific clinic for further outpatient evaluation. CONCLUSION:Emergency Department providers believe approximately 30% of patients seeking emergency care for chest pain at low risk for ACS have anxiety as a primary problem, yet fewer than half discuss this concern or provide information to help the patient manage anxiety. This highlights an opportunity for patient centered communication.
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Project description:OBJECTIVE:To describe delivery of recommended HIV care and work satisfaction among infectious disease (ID) physicians, non-ID physicians, nurse practitioners (NPs), and physician assistants (PAs). DATA SOURCES:Medical Monitoring Project 2013-2014 HIV Provider Survey. STUDY DESIGN:Population-based complex sample survey. DATA COLLECTION/ANALYSIS METHODS:We surveyed 2208 HIV care providers at 505 US HIV care facilities and computed weighted percentages of provider characteristics, stratified by provider type. Rao-Scott chi-square tests and logistic regression used to compare characteristics of ID physicians with each other provider type. PRINCIPAL FINDINGS:The adjusted provider response rate was 64 percent. Among US HIV care providers, 45 percent were ID physicians, 35 percent non-ID physicians, 15 percent NPs, and 5 percent PAs. Satisfaction with administrative burden was lowest among non-ID physicians (27 percent). Compared with ID physicians, satisfaction with remuneration was lower among non-ID physicians and higher among NPs (37, 28, and 51 percent, respectively). NPs were more likely than ID physicians to report performing four of six services that are key to providing comprehensive HIV care, but more NPs planned to leave clinical practice within 5 years (19 vs 7 percent). CONCLUSION:Addressing physician dissatisfaction with remuneration and administrative burden could help prevent a provider shortage. Strengthening the role of NPs may help sustain a high-quality workforce.
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Project description:For youths with life-limiting conditions, little is known regarding families' understanding of their adolescent's wishes for end-of-life (EOL) care.To examine congruence in HIV positive adolescents and their families' thoughts about death and dying.The Lyon Advance Care Planning Survey-Adolescent and Surrogate versions were administered within a randomized controlled trial. Participants (n=48) were medically stable adolescents aged 14-21 years with HIV/AIDS and their families. Congruence was measured by intraclass correlation coefficients (ICCs) for continuous variables and by kappa for ordinal or dichotomous responses.Adolescent participants were as follows: mean age 16.6 years (range 14-21); 37.5% males; 92% African American; 38% CD4 count <200; and viral load mean=32,079 copies/mL (range <400-91,863 copies/mL). Adolescent/family dyads agreed that it is important to complete an advance directive to let loved ones know their wishes (21/24 dyads), yet no dyads agreed an advance directive had been completed. Dyads endorsed incongruent thoughts about the adolescent being afraid of dying in pain (64%; congruent afraid=8 dyads, kappa=-0.0769) and being off life support machines (congruent important=9 dyads, ICC=-0.133, 95% confidence interval = -0.540, 0.302, P=0.721). Families' knowledge of teens' preferences for the timing of EOL conversations (early vs. late in course of illness) was poor (kappa=-0.1186). Adolescents (90%) wanted to talk about EOL issues before they entered the dying phase.Although important areas of congruence emerged, equally important areas, such as the timing of these conversations and adolescents' EOL needs and wishes, are not known by their families. Families need help initiating conversations to assure that their adolescents' EOL wishes are known to them.
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Project description:This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization.Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization.The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ?=-.30, p<.01), suggesting potential underdosing of more dependent smokers.During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.
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Project description:Living donor liver transplantation (LDLT) remains underutilized in the United States. Barriers to LDLT and acceptance of nondirected living liver donation (ND-LLD) and liver paired exchange (LPE) are unclear. The medical and surgical directors of 99 unique transplantation programs (56 LDLT programs and 43 non-LDLT programs) were surveyed to gain insight into perceptions and practices of LDLT and types of donors utilized. The response rate was 84%. Most LDLT programs (65%) reported performing ND-LLD, though opinions regarding allocation and the need for additional evaluation of these donors were mixed. Only a minority of LDLT programs reported performing LPE (12%), but most programs (78%) would be open to cross-institutional LPE barring logistical barriers. There were significant differences between LDLT and non-LDLT programs with regard to perceived barriers to LDLT, with LDLT programs reporting mainly donor and recipient factors and non-LDLT programs reporting institutional factors (P < 0.001). Understanding perceptions and practices of LDLT, ND-LLD, and LPE is important to aid in the growth of LDLT.
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