ADDRESSING HIV RISK AND HEALTH CARE NEEDS UNDER HMO

描述：(申请人摘要) 我们建议开发、实施和评估心理医学外展 将干预措施(POI)纳入初级卫生保健系统 旨在帮助注射吸毒者的管理性医疗新政策 增加对包括药物治疗在内的卫生保健的利用，减少艾滋病毒 危险行为和药物使用，并改善其健康状况。建议数 这项研究是一项前瞻性随机试验，比较了 干预(POI)和标准外展干预。建议的POI 是一种综合性的社区和医疗/药物治疗服务模式。 重点将放在加强外展战略和心理医疗支持上 外展工作人员充当榜样、调解员/经纪人的服务 在参与者和心理医疗服务之间，以及动机代理人之间 帮助参与者接受患者/客户的角色。精神科护士 受过激励性面试培训的人会把精力集中在改变 危险行为，包括吸毒和进入医疗保健服务， 包括药物治疗。激励性面试将是 变化的过程，并将由普罗查斯卡和迪克莱门特的阶段指导 变更流程模型。将从以下人员中招募600名注射吸毒者 阿雷西博卫生区的社区，并随机分配到 介入臂。招聘社区的选择将基于 家庭收入中位数和林区的存在。抽样调查 设计遵循三阶段随机选择招聘地点的过程，DAY 和招募时间，以及挑选一名潜在参与者 指定的地点、日期和时间。对于主要分析，我们将重点放在 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不平衡的协变量 在两个干预组中，其效果可能被统计调整为 将协变量纳入Logistic或多元回归模型。 主要分析的第二步将是考虑“调解” 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 将对每个陈述的结果进行成本估算.的总成本 将使用管理型医疗保健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.