HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.
HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.
复制标题
DOI：
10.1186/s12889-016-3152-4
复制
发表时间：
2016-06-10
影响因子：
4.5
通讯作者：
Bertolli J
中科院分区：
文献类型：
--
作者：
Dombrowski JC;Carey JW;Pitts N;Craw J;Freeman A;Golden MR;Bertolli J
美国卫生部门历来没有使用艾滋病毒监测数据对个人进行疾病控制干预，但艾滋病毒治疗和监测方面的进步正在改变公共卫生实践。美国许多卫生部门正处于实施“数据护理”计划的早期阶段，该计划旨在根据为艾滋病毒监测收集的信息，帮助艾滋病毒感染者 (PLWH) 参与护理。利益相关者的参与是开发这些计划的关键的第一步。在华盛顿州西雅图-金县，卫生部门对艾滋病毒医疗保健提供者和艾滋病病毒感染者进行了采访，以告知其“数据护理”计划。本文描述了这些采访的关键主题，并追踪了最终节目的演变。疾病干预专家对 20 名从 HIV 监测中随机选出的 20 名 PLWH 进行了单独的半结构化定性访谈，这些患者在 2009 年至 2010 年期间 HIV RNA 水平 > 10,000 拷贝/mL。一名医生调查员对 15 名艾滋病毒医疗保健提供者进行了重要知情人访谈。调查人员分析了去识别化的访谈笔录，开发了主题密码簿，对访谈进行了独立编码，并确定了最常用的代码以及这些关键主题的说明性引用。我们还追溯了该计划从 2010 年到 2015 年的演变。感染者普遍接受卫生部门帮助感染者参与护理的想法，并描述了了解艾滋病毒血清阳性同伴的治疗经历将如何帮助他们参与护理。尽管许多医生支持“从数据到护理”的概念，但其他人对卫生部门可能侵犯患者隐私和医患关系表示担忧。提供者强调卫生部门需要与现有的努力进行协调，以提高患者的参与度。根据访谈的结果，西雅图-金县的“数据护理”计划旨在纳入艾滋病毒阳性同伴组成部分，并确保在重新将患者与护理联系起来的过程中与艾滋病毒护理提供者进行协调。卫生部门可以通过收集主要利益相关者（例如艾滋病毒医疗和社会服务提供者）的意见，并与基于诊所的工作进行协调，使患者重新参与护理，从而为“数据护理”工作提供支持。
U.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing “Data to Care” programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program. Disease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009–2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015. PLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV-positive peer component and to ensure coordination with HIV care providers in the process of relinking patients to care. Health departments can build support for Data to Care efforts by gathering input of key stakeholders, such as HIV medical and social service providers, and coordinating with clinic-based efforts to re-engage patients in care.