Health Professionals’ Patient-Practitioner Orientation and Substance Abuse Attitudes – a Latent Class Analysis

Introduction: Although substance use disorder (SUD) has been recognized as a disease, the view that SUD is a choice has survived in the general population. Individuals with SUD’s continue to be viewed as violent, manipulative, and have poor motivation for treatment. Health professionals who share such attitudes tend to interfere with progress in treatment. Alternatively, providers who acknowledge their critical role in addressing the substance problem with the patient and the need to build provider-patient trust tend to be more effective. It is this finding which forms the intersection to patient-centered care (PCC). This is the first study to inspect the co-occurrence of SUD attitude and PCC in a sample of students in social work, counseling psychology, nursing, and medical residents.

Methods: Data are from 205 medical professional students who participated in a SBIRT Training and evaluation conducted at an urban historically black university. Students provided baseline information on the Patient-Practitioner Orientation Scale (PPOS) and the Brief Substance Abuse Attitude Survey (BSAAS). Latent Class Analysis was used to empirically determine the number of latent profiles to depict the co-occurrence of PPOS and BSAAS. Recommended information criteria and likelihood-based ratio tests were used in addition to considerations of interpretability and parsimony to select a model with the optimal number of classes. Relevant covariates were included to further characterize students assigned to one of the profiles.

Results: The students differentiated into three profiles. The first profile (41.9%) were strongly patient-centered, held optimistic attitudes about treatment success, and viewed individuals with SUD in a non-moralizing way. The second profile (10.6%) scored very low on patient-centeredness, and showed permissive, non-stereotypical and non-moralizing attitudes towards individuals with SUD. The third profile (47.5%) scored low on patient-centeredness, and held less positive opinions about individuals with SUD and treatment success. Using the third profile as reference group, African-American students were 2.4 times more likely to be in the first profile (OR=2.4, p<.05). Using the second profile as reference group, students in medical disciplines were over four times likely being in first profile (OR=4.2, p<.05).

Conclusions: The finding that close to 2/3 of the students scored low on patient-centeredness, and half held stereotypical attitudes towards individuals with SUD, supports the need for further training for students in allied heath disciplines. Further evaluations will determine whether the SBIRT training program is able to address this need.