IMPOVING PHYSICIAN SEXUAL RISK ASSESSMENT/COUNSELING

艾滋病毒和其他性传播疾病造成了巨大的损失， 社会在经济资源消耗、人类苦难 年复一年，失去了生命。 预防是最好的方法， 遏制性病流行，因为许多人没有治愈方法或疫苗， 初级保健医生在预防性病方面可以发挥重要作用 艾滋病毒和其他性病的传播，通过评估病人的危险性行为， 行为和提供风险降低咨询。 尽管许多 有声望的组织呼吁医生提供这些 重要的预防服务，许多美国医生目前没有做 是的 试图诱使医生进行性风险评估， 提供风险降低咨询必须满足于一般障碍， 提供预防服务和讨论风险的具体障碍 与病人的性行为。 目前这项为期四年的研究拟在一个对照的随机 审判，一个密集的九个月的干预，解决了许多 医生进行性风险评估的障碍， 提供减少风险咨询。 干预的目的 是提高初级保健医生的技能， 快速并常规地执行这些任务，所有患者都有目标 探访 初级保健医生将被随机分配到对照组 或实验组。 衡量性风险的表现 评估和风险降低咨询将在测试前，测试后， 和9个月的随访。 将获得主要结局指标 在目标访视后通过电话采访患者， 医生 在为期9个月的干预期间， 实验组将收到注重实践通讯， 在以下患者的病历中插入病历提醒系统 所有接受目标访视的患者，并将参加两个阶段的 以技能为基础的课程，间隔三个月。 课程将包括 讲座，触发录像带，和角色扮演与病人导师。 该项目有可能显著影响医生的 提供性风险评估和减少风险的做法 辅导 通过帮助所有患者了解他们 可能会使自己处于感染性病的危险之中，这些预防措施 在遏制艾滋病和其他疾病的传播方面， 性病

HIV and other sexually transmitted diseases exact an enormous toll on society in terms of economic resources expended, human suffering inflicted, and years of life lost. Prevention is the best means for curbing the STD epidemics because there are no cures or vaccines for many STDs Primary care physicians can play an important role in preventing the spread of HIV and other STDs by assessing patients for risky sexual behaviors and by providing risk reduction counseling. Although many prestigious organizations have called for physicians to provide these important preventive services, many US physicians are not currently doing so. Attempts to induce physicians to perform sexual risk assessments and provide risk reduction counseling must content with general barriers to providing preventive services and specific barriers to discussing risky sexual behavior with patients. The present four-year study proposes to test, in a controlled randomized trial, an intensive nine-month intervention that addresses many of the barriers to physicians' performance of sexual risk assessments and provision of risk reduction counseling. The purpose of the intervention is to improve the skills of primary care physicians so that they will perform these tasks quickly and routinely with all patients having target visits. Primary care physicians will be randomly assigned to a control or experimental group. Measurement of performance of sexual risk assessment and risk reduction counseling will occur at pretest, posttest, and nine-month follow-up. The primary outcome measure will be obtained by telephone interviews with patients after target visits with their physicians. During the nine-month intervention period, physicians in the experimental group will receive Practice-oriented Newsletters, will have a Medical Record Reminder System inserted in the medical charts of all patients receiving target visits, and will attend two segments of a Skills-based Course, separated by three months. The course will contain lectures, trigger videotapes, and role playing with patient instructors. This project has the potential to significantly impact physicians' practices in providing sexual risk assessments and risk reduction counseling. By helping all patients understand the ways in which they may be placing themselves at risk of contracting an STD, these preventive practices could play a role in containing the spread of AIDS and other STDs.