PHYSICANS ROLE IN REDUCING PATIENTS ALCOHOL/HIV RISKS

申请人摘要：酒精滥用和艾滋病毒/艾滋病造成重大 发病率和死亡率在美国，与毁灭性的健康， 社会和经济后果。 初级卫生保健机构提供理想的 开展预防工作以减少这一发病率的地点， mortality. 因为病人认为初级保健医生是可信的 健康信息的来源，医生有可能影响 患者的危险行为。 然而，大多数人并不评估或建议 尽管长期以来一直有人呼吁他们这样做， 是的 到目前为止，很少有研究测试减少障碍的策略 面对医生，我们知道没有研究已经检查了 医生参与酒精或艾滋病毒预防工作重要性 干预措施。 我们建议测试医生行为改变的有效性 提高医生知识、态度和行为的干预措施 关于减少病人的酒精和艾滋病风险。 医生随机 分配到实验组的学生将接受2小时的干预 包括以技能为基础的课程和以实践为基础的通讯;他们 还将接受两次强化训练 我们还建议比较 四种干预措施对减少初级保健患者的 酒精和艾滋病风险行为：一个医生指导的简短干预， 医生指导的强化干预，计算机指导的简报 干预，或计算机指导的强化干预。 高危 将通过计算机化风险评估工具识别患者， 在医生组内随机分配到四种干预措施之一。 在医生指导的简短干预中，患者将接受 5-他们的初级保健医生的分钟干预，旨在告知 了解他们的风险，建议他们减少危险行为，帮助他们 帮助他们设定行为改变目标，并让他们接受咨询。 服务 在医生指导的强化干预中， 接受同样的5分钟干预，并转介到四个会议MET 由经过专门培训的健康风险顾问进行干预。 医生会把病人介绍给顾问， 个月，与患者单独会面四次， 基于MET模型的酒精和艾滋病毒干预，已被证明， 有效减少酗酒问题。 在电脑指导的简报中 干预，计算机将告知患者他们的酒精和艾滋病毒 风险，建议他们降低风险，帮助他们建立行为 改变目标，让他们去咨询。 在计算机指导下， 强化干预，患者将接受相同的简短干预 再加上立即转介给健康风险顾问， 任命开始四届MET干预。 主要结局 措施将是减少患者的酒精和艾滋病毒的风险， 基线时、干预后（基线后3个月） 评估）和6个月随访评估。 如果像我们假设的那样，干预有效地降低了患者的风险， 行为，这种干预可以通过其他卫生保健实施， 减少与酒精有关的发病率和死亡率的环境， 艾滋病毒危险行为。

APPLICANT'S ABSTRACT: Alcohol misuse and HIV/AIDS cause significant morbidity and mortality in the United States, with devastating health, social, and economic consequences. Primary health care settings offer ideal locations to initiate prevention efforts to reduce this morbidity and mortality. Because patients view primary care physicians as credible sources of health information, physicians have the potential to influence patients' risky behaviors. Yet the majority do not assess or counsel patients for alcohol or HIV risks despite long-standing calls for them to do so. To date, few studies have tested strategies for reducing the barriers facing physicians and we know of no studies that have examined the importance of physician involvement in alcohol- or HIV-preventive interventions. We propose to test the effectiveness of physician behavioral change intervention on improving physicians' knowledge, attitudes, and practices regarding reducing patients' alcohol and HIV risks. Physicians randomly assigned to an Experimental Group will receive a 2-hour intervention consisting of a skills-based course and practice-based newsletters; they will also receive two booster-training sessions. We also propose to compare the effectiveness of four interventions to reduce primary care patients' alcohol-and HIV-risk behaviors: a physician-directed brief intervention, a physician-directed intensive intervention, a computer-directed brief intervention, or a computer-directed intensive intervention. At-risk patients will be identified by a computerized risk assessment tool and randomly assigned within physician groups to one of the four interventions. In the physician-directed brief intervention, patients will receive a 5-minute intervention from their primary care physicians aimed at informing them about their risks, advising them to reduce risky behaviors, assisting them in setting behavioral change goals, and referring them to counseling services. In the physician-directed intensive intervention patients will receive the same 5-minute intervention plus referral to a four-session MET intervention to be conducted by a specially trained health-risk counselor. Physicians will introduce patients to the counselors who will, over three months, meet individually with patients for four sessions to deliver an alcohol and HIV intervention based on the MET model, which has been shown to be effective at reducing problem drinking. In the computer-directed brief intervention, the computer will inform patients about their alcohol and HIV risks, advise them to reduce their risks, assist them in setting behavioral change goals, and refer them to counseling. In the computer-directed intensive intervention, patients will receive the same brief intervention plus immediate referral to the health-risk counselor to schedule an appointment to begin the four-session MET intervention. The main outcome measures will be reductions in patients' alcohol and HIV risks as assessed by computer at baseline, post-intervention (3 months after the baseline assessment), and at a 6-month follow-up assessment. If, as we hypothesize, the intervention effectively reduces patients' risk behaviors, this intervention could be implemented by other health care settings to reduce the morbidity and mortality associated with alcohol and HIV risk behaviors.