ADDRESSING HIV RISK AND HEALTH CARE NEEDS UNDER HMO

描述：（申请人摘要） 我们建议制定、实施和评估一项心理医学外展计划， 在初级卫生保健系统内整合的干预措施（POI） 一项旨在帮助注射毒品使用者的管理式护理新政策 更多地利用保健，包括药物治疗，减少艾滋病毒 危险行为和药物使用，并改善他们的健康状况。 拟议 这项研究是一项前瞻性随机试验， 标准外展干预（Standard Outreach Intervention） 建议的POI 是一个综合社区和医疗/戒毒治疗服务模式。 重点将是加强外联战略和心理医疗支助 外联工作者充当榜样、调解人/中间人的服务 参与者和心理医疗服务之间的联系，以及激励代理人， 帮助参与者接受患者/客户角色。 精神科护士 受过激励性面试训练的人会把精力集中在改变 危险行为，包括吸毒和进入卫生保健服务， 包括药物治疗。 动机性面试将是 变化过程，并将由Prochaska和DiClemente的阶段指导 变革过程模型。 将从以下国家招募600名注射吸毒者： 阿雷西博卫生区的社区，并随机分配到 招募社区的选择将基于 中等家庭收入和科平地区的存在。 采样 设计遵循招募地点的3阶段随机选择过程， 和招聘时间，并选择一个潜在的参与者 指定地点、日期和时间。 对于主要分析，我们将重点关注 比较两个干预组的各种结果指标。 如果初步分析检测到一个协变量， 在两个干预组中，其效果可以通过以下方式进行统计调整： 将协变量并入逻辑回归或多元回归模型。 委托人分析的第二步是考虑“中介 “影响”在我们的设计。 在这个分析中，我们希望发现， 实验臂的干预对应于 干预 最后，将进行成本效益分析。 为 将对每一项所述成果的成本进行估算。 的总成本 将使用管理式医疗的索赔数据估计资源使用情况 在该地区提供服务的组织。

DESCRIPTION: (Applicant's Abstract) We propose to develop, implement and evaluate a Psychomedical Outreach Intervention (POI) integrated within a primary health care system under the new policy of managed care and aimed at helping injection drug users (IDUs) increase utilization of health care, including drug treatment, reduce HIV risk behaviors and drug use, and improve their health status. The proposed study is a prospective randomized trial comparing an experimental intervention (POI) with a Standard Outreach Intervention. The proposed POI is an integrative community and health care/drug treatment services model. The focus will be on an enhanced outreach strategy and psychomedical support services where outreach workers serve as role models, mediators/brokers between participants and psychomedical services, and motivation agents to help participants accept the patient/client role. Psychiatric nurses trained in motivational interviewing will focus their effort on changing risk behaviors, including drug use, and entering health care services, including drug treatment. Motivational Interviewing will be the approach to the change process, and will be guided by Prochaska and DiClemente's Stages of Change Process Model. A total of 600 IDUs will be recruited from communities of the Arecibo Health Region and randomly assigned to either intervention arm. The recruitment communities will be selected based on median family income and the existence of copping areas. The sampling design follows a 3-stage random selection process of recruitment sites, day and time of recruitment, and selection of a potential participant on the designated site, day and time. For the principal analysis we will focus on comparing the various outcome measures across the two intervention groups. If the preliminary analyses detect a covariate which is not balanced across the two intervention groups, its effect may be statistically adjusted by incorporating the covariate into a logistic or multiple regression model. The second step in the principal analysis will be to consider the "mediating effects" in our design. In this analysis, we wish to discover whether intervention of the experimental arm corresponds to the actual effect of the intervention. Finally, cost-effectiveness analyses will be conducted. For each of the stated outcomes a cost will be estimated. The total cost of resources use will be estimated using claims data from managed care organizations providing services in the area.