Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

技术增强社区健康护理以减少 PID 后复发性传播感染

• 批准号: 8604755
• 负责人: MARIA E. TRENT
• 金额: $ 51.06万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8604755
• 关键词: Acute; Adherence; Adolescent; Adolescent and Young Adult; Age; Attention; Baltimore; Behavior; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Clinical; Clinical Management; Clinical Trials; Clinical Trials Design; Communication; Communities; Community Health Nurse Specialist; Community Health Nursing; Control Groups; Cost Control; Data; Diagnosis; Disease; Ectopic Pregnancy; Educational Curriculum; Effectiveness; Enrollment; Female Adolescents; Fertility; Health; Health Personnel; Health Professional; Healthcare; Hospitalization; Infection; Infection prevention; Infertility; Inflammatory; Inpatients; Intervention; Maintenance; Medical; Medical Care Team; Minority; Modeling; Outcome; Outpatients; Parents; Patients; Pelvic Inflammatory Disease; Penetration; Prevention Protocols; Public Health; Randomized; Randomized Controlled Trials; Recurrence; Reproductive Health; Reproductive Tract Infections; Research; Research Activity; Resources; Risk; Self Care; Self Management; Services; Sexual Health; Sexually Transmitted Diseases; Technology; Teenagers; Text; Training; Tubal Pregnancy; United States; Visit; Vulnerable Populations; Woman; Work; Youth; brief intervention; chronic pelvic pain; clinical care; compare effectiveness; cost; cost effective; cost effectiveness; disorder prevention; evidence base; experience; follow-up; group intervention; health care service utilization; high risk; improved; medication compliance; nursing intervention; randomized trial; reproductive health intervention; research clinical testing; response; screening; standard care; standard of care; treatment strategy; young adult; young woman

DESCRIPTION (provided by applicant): Pelvic Inflammatory Disease (PID) remains a serious reproductive health disorder and disease rates remain unacceptably high among minority adolescent girls and young adult women. Each episode of this upper reproductive tract infection, usually caused by a sexually transmitted infection (STI), increases the risk for multiple squeal including tubal infertility, ectopic pregnancy, and chronic pelvic pain (CPP). Care for PID has shifted from the inpatient to the outpatient setting; however, our age-stratified analysis of national data shows that adolescents continued to have high rates of repeat STIs and CPP, regardless of treatment strategy. Our local clinical trial data has also shown that urban adolescents have poor adherence to the 3 day clinical follow- up visit recommended by the Centers for Disease Control and Prevention (CDC), are at high risk for STI at the 90-day STI re-screening visit, and that brief interventions in the acute care setting have positive, but modest effects on adherence to self-management behaviors. Inpatient treatment for PID is expensive without incremental increases in effectiveness when compared with outpatient treatment so developing outpatient strategies to improve short and long-term reproductive health outcomes, including recurrent STI and PID, are warranted. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources enhance health care utilization and promote risk-reducing behavior among adolescents. Recent research has also shown that use of short messaging service (SMS) messaging can enhance clinical care by improving attention to medical visits, medication adherence, and communication with the health care team. The primary aim of this project is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N) intervention to an optimized standard of care control group using randomized trial design. We hypothesize that repackaging the recommended CDC-PID follow-up visit using the TECH-N will be cost-effective compared with standard of care and reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse. We have demonstrated that our team of trained community-oriented health professionals can follow adolescent girls with PID in the community and that utilizing CHNs to optimize treatment in the post-PID period is feasible and acceptable to adolescents and parents in urban communities. Our pilot using SMS communication also demonstrates that urban adolescent girls have access to cell phone technology, eagerly accept SMS as a communication strategy, and respond to health provider queries for sexual health maintenance support. We propose to enroll 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive the TECH-N intervention which includes CHN clinical support using a single post-PID face-to-face clinical evaluation that incorporates an evidence based STI prevention curriculum and SMS communication support during the 30-day period following diagnosis (intervention group) or the standard of care (control group).

描述（由申请人提供）：盆腔炎（PID）仍然是一种严重的生殖健康疾病，少数民族少女和年轻成年妇女的发病率仍然高得令人无法接受。这种上生殖道感染的每次发作通常由性传播感染（STI）引起，增加了包括输卵管性不孕、异位妊娠和慢性盆腔疼痛（CPP）在内的多重尖叫的风险。PID的治疗已经从住院病人转移到门诊病人；然而，我们对国家数据的年龄分层分析表明，无论采用何种治疗策略，青少年重复性传播感染和CPP的比例仍然很高。我们当地的临床试验数据也显示，城市青少年对疾病控制和预防中心（CDC）推荐的3天临床随访的依从性较差，在90天的STI重新筛查访问中感染STI的风险较高，并且在急性护理环境中的短暂干预对坚持自我管理行为有积极但适度的影响。与门诊治疗相比，盆腔炎的住院治疗费用昂贵，而且效果没有增加，因此制定门诊策略来改善短期和长期生殖健康结果，包括复发性传播感染和盆腔炎，是有必要的。社区卫生护士（CHN）干预措施已被证明可以增加获得适当资源的机会，提高卫生保健的利用率，并促进青少年减少风险的行为。最近的研究还表明，使用短信服务（SMS）可以通过提高对医疗访问的关注、药物依从性和与卫生保健团队的沟通来增强临床护理。本项目的主要目的是采用随机试验设计比较技术增强社区卫生护理干预（TECH-N）干预与优化护理标准对照组的有效性。我们假设，与标准护理相比，使用TECH-N重新包装推荐的CDC-PID随访将具有成本效益，并通过提高对PID治疗的依从性和减少无保护性交来降低短期重复感染率。我们已经证明，我们训练有素的社区卫生专业人员团队可以在社区中跟踪患有PID的青春期女孩，并且利用chn优化PID后时期的治疗对于城市社区的青少年和父母来说是可行和可接受的。我们使用短信通信的试点也表明，城市少女可以使用手机技术，热切地接受短信作为一种通信策略，并回应卫生保健提供者的性健康维护支持查询。我们建议在巴尔的摩招募350名13-21岁诊断为PID的年轻女性，并随机分配她们接受TECH-N干预，其中包括在诊断（干预组）或标准护理（对照组）后30天内使用单一PID后面对面临床评估的CHN临床支持，包括基于证据的STI预防课程和短信通信支持。