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PHYSICANS ROLE IN REDUCING PATIENTS ALCOHOL/HIV RISKS

医生在降低患者酒精/艾滋病毒风险方面的作用

基本信息

批准号：
6371463
负责人：
BARBARA Joan GERBERT
金额：
$ 23.23万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
1998
资助国家：
美国
起止时间：
1998-09-30 至 2003-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6371463
关键词：
AIDS education /prevention alcoholism /alcohol abuse prevention attitude behavior therapy behavioral /social science research tag clinical research computer assisted instruction human subject primary care physician role

项目摘要

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.

申请者摘要：酗酒和艾滋病毒/艾滋病会导致美国的发病率和死亡率，以及毁灭性的健康，社会和经济后果。初级卫生保健设置提供理想的开展预防工作以减少这种发病率的地点和死亡率。因为患者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患者酗酒或感染艾滋病毒的风险，尽管长期呼吁他们这样做所以。到目前为止，很少有研究测试降低障碍的策略面对医生，我们知道没有研究检查过医生参与酒精或艾滋病毒预防的重要性干预措施。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降低患者的酒精和艾滋病毒风险。医生随机选择分配到试验组的人将接受2小时的干预由以技能为基础的课程和以实践为基础的通讯组成；他们还将接受两次助推器培训。我们还建议将四种干预措施降低初级保健病人死亡率的效果酒精和艾滋病毒危险行为：医生指导的短暂干预医生指导的强化干预，计算机指导的简报干预，或计算机控制的密集干预。处于危险之中患者将通过计算机化的风险评估工具进行识别，并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，患者将接受初级保健医生提供5分钟干预，旨在告知告诉他们自己的风险，建议他们减少危险行为，协助帮助他们设定行为改变目标，并让他们接受心理咨询服务。在医生指导的强化干预中，患者将接受同样的5分钟干预，并转介到四次会议的MET 由受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咨询师，而咨询师会在三年多的时间里几个月，单独与患者会面四次会议，以提供基于MET模型的酒精和艾滋病毒干预，已被证明有效地减少问题饮酒。在电脑指导的简报中干预后，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，让他们接受心理咨询。在计算机指导下强化干预，患者将接受同样短暂的干预外加立即转介给健康风险顾问，以安排预约开始为期四天的MET干预。主要结果是措施将是根据评估减少患者的酒精和艾滋病毒风险通过计算机在基线、干预后(基线后3个月)进行评估)，并进行为期6个月的后续评估。如果正如我们假设的那样，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医疗保健来实施减少与酒精相关的发病率和死亡率的环境艾滋病毒危险行为。