Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach.
Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach.
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通过使用混合方法的方法评估，扩大了阿拉巴马州艾滋病毒艾滋病毒患者获得艾滋病毒患者的药物使用服务和心理保健的机会。
DOI：
10.1186/s12913-022-08280-z
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发表时间：
2022-07-15
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
亚拉巴马州是全国结束艾滋病毒流行倡议的七个优先州之一，因为农村疾病负担很大。精神健康（MH）和物质使用障碍（SUD）是缺乏医疗补助扩展和基础设施的农村地区艾滋病毒护理的障碍。远程保健等循证技术可能会加强可持续发展和卫生保健服务，但在农村地区仍未得到充分研究。我们进行了准备评估，使用混合方法的方法，探索机会，加强SUD和MH筛查使用电子病人报告的结果（ePRO）和远程医疗在五个瑞安白色艾滋病毒/艾滋病计划资助的诊所AL。诊所提供者和工作人员从每个网站（N = 16）完成了组织准备实施变革（ORIC）评估和采访现有的服务和准备改变。来自每个地点的艾滋病毒感染者（PLH，N = 18）完成了关于医疗保健技术可接受性和可及性的调查。调查和访谈显示，所有诊所每年使用患者健康问卷9（PHQ 9）筛查抑郁症。SUD筛查频率较低且不标准化。所有站点都提供远程医疗服务，五个站点中有三个由于COVID-19大流行而开始提供服务;然而，MH和SUD服务的远程医疗服务在站点之间并不标准化。结果表明，总体上愿意采用标准化筛查，并将远程保健服务扩大到诊所艾滋病毒服务之外。有几个问题，包括Wi-Fi接入，工作人员的能力，和病人的技术素养。18名艾滋病毒感染者（PWH），年龄在18至65岁之间，参加了调查，所有人都表现出足够的技术素养。大多数人已经获得远程保健，并不担心它过于复杂或限制通信。有人担心缺乏面对面的互动，缺乏体检和高质量的远程保健护理。这项对PWH和为他们服务的诊所的研究揭示了利用技术在农村地区扩大SUD和MH服务的机会。需要改进的领域包括实施常规SUD筛查，扩大远程保健，同时保持面对面互动的机会，以及使用由患者完成的标准化ePRO，以尽量减少耻辱和偏见。
Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a large rural burden of disease. Mental health (MH) and substance use disorders (SUD) represent obstacles to HIV care in rural areas lacking Medicaid expansion and infrastructure. Evidence-informed technologies, such as telehealth, may enhance SUD and MH services but remain understudied in rural regions. We conducted a readiness assessment using a mixed methods approach to explore opportunities for enhanced SUD and MH screening using electronic patient reported outcomes (ePROs) and telehealth at five Ryan White HIV/AIDS Program-funded clinics in AL. Clinic providers and staff from each site (N = 16) completed the Organizational Readiness to Implement Change (ORIC) assessment and interviews regarding existing services and readiness to change. People with HIV from each site (PLH, N = 18) completed surveys on the acceptability and accessibility of technology for healthcare. Surveys and interviews revealed that all clinics screen for depression annually by use of the Patient Health Questionnaire-9 (PHQ9). SUD screening is less frequent and unstandardized. Telehealth is available at all sites, with three of the five sites beginning services due to the COVID-19 pandemic; however, telehealth for MH and SUD services is not standardized across sites. Results demonstrate an overall readiness to adopt standardized screenings and expand telehealth services beyond HIV services at clinics. There were several concerns including Wi-Fi access, staff capacity, and patients’ technological literacy. A sample of 18 people with HIV (PWH), ages 18 to 65 years, participated in surveys; all demonstrated adequate technology literacy. A majority had accessed telehealth and were not concerned about it being too complicated or limiting communication. There were some concerns around lack of in-person interaction and lack of a physical exam and high-quality care with telehealth. This study of PWH and the clinics that serve them reveals opportunities to expand SUD and MH services in rural regions using technology. Areas for improvement include implementing routine SUD screening, expanding telehealth while maintaining opportunities for in-person interaction, and using standardized ePROs that are completed by patients, in order to minimize stigma and bias.
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影响因子：
4.2
作者：
Eaton, Ellen F.;Tamhane, Ashutosh;Turner, Wesli;Raper, James L.;Saag, Michael S.;Cropsey, Karen L.
通讯作者：
Cropsey, Karen L.
影响因子：
7.4
作者：
Mackert M;Mabry-Flynn A;Champlin S;Donovan EE;Pounders K
通讯作者：
Pounders K
DOI：
10.2471/blt.04.019307
发表时间：
2006-02-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Bussmann, Hermann;Wester, C William;Marlink, Richard G
通讯作者：
Marlink, Richard G
影响因子：
11.8
作者：
Kozak, Michael S.;Mugavero, Michael J.;Willig, James H.
通讯作者：
Willig, James H.
影响因子：
2.1
作者：
Myers, Carole R.
通讯作者：
Myers, Carole R.