Addressing Dental and Psychiatric Comorbidities: Screening and Referrals of HIV/AIDS Patients

解决牙科和精神合并症：艾滋病毒/艾滋病患者的筛查和转诊

• 批准号: 10671164
• 负责人: Sangeeta Gajendra
• 金额: $ 19.25万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2025-09-05
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671164
• 关键词: Address; Administrator; Affect; Appointment; Behavior; Behavioral; Biological; Biological Markers; Caring; Case Management; Case Manager; Climate; Clinic; Clinical Data; Competence; Complex; Data; Dental; Dental Anxiety; Dental Care; Dental Health Services; Dental Insurance; Dentists; Development; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Focus Groups; Foundations; Frequencies; Funding; Future; General Population; Grant; HIV; HIV/AIDS; Health Care Costs; Health Professional; Health Services Accessibility; Health Status; Health behavior; Healthcare; Human Resources; Immune system; Individual; Inflammation; Informal Social Control; Interleukin-6; Intervention; Interview; Measures; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; Motivation; Mouth Diseases; Oral Health Impact Profile; Oral health; Outcome; Outcome Study; Participant; Patients; Perception; Periodontal Diseases; Persons; Population; Prevalence; Prospective Studies; Psyche structure; Questionnaires; Recommendation; Role; Salivary; Sampling; Self Administration; Self Determination; Self Management; Surveys; Transportation; Treatment outcome; Underserved Population; United States National Institutes of Health; clinical examination; comorbidity; comparison group; evidence base; health disparity; health service use; improved; indexing; individual patient; informant; innovation; motivational enhancement therapy; patient population; patient screening; programs; psychiatric comorbidity; randomized, clinical trials; screening; service providers; social; success; theories; tool

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services, compared to the general population. Psychiatric and dental comorbidities in PLWHA result in diagnostic complexities, treatment gaps, increased health care costs and poorer outcomes. Early diagnosis and treatment access are imperative. There are no US studies of co-occurring oral diseases and mental illnesses in PLWHA. Assessment of treatment needs, self-management, and case management can inform improved referral and treatment outcomes. Studies have identified barriers to dental care in PLWHA, including ability to pay, dental anxiety, transportation, etc. Patients, HIV program directors, case managers and administrators are key stakeholders in understanding PLWHA use of dental and mental health services. Their referral success has not been assessed through traditional HIV surveillance. Factors for successful referral of PLWHA to mental health and dental services are understudied. Examining linkage factors as perceived by PLWHA, program directors and other staff, including the role of motivational Self-Determination Theory-based (SDT) mechanisms is needed. The proposed study will examine factors related to referrals of PLWHA to dental and mental health services and to describe the prevalence of comorbidities in 105 PLWHA, their self- management, and their perception of case management. All patients (with or without co-morbidities) will be assessed. The primary study outcome is keeping dental and/or mental health referral appointments. AIM 1: To examine referral linkage factors (social, biological, or behavioral) in those screened for 1) oral diseases only, 2) mental illness only, 3) both oral diseases and mental illness, or 4) neither (comparison group). Other assessments include 8 key informant interviews (KIIs), 2 focus groups (FGs) with 8-12 participants each and validated surveys. AIM 2: 2a) To describe the prevalence of comorbidities in a sample of PLWHA, the use of self-management strategies and their referral need based on screening and clinical data (periodontal inflammation via salivary biomarker IL-6 at baseline); 2b) To assess feasibility and obtain pilot data to inform a future motivation-based intervention targeting oral and mental health behavior in PLWHA. AIM 3: To examine health status at six months via patient screenings, clinical examination with salivary biomarkers, and a survey. Hypothesis: PLWHA screening positive for dental/mental comorbidities will keep fewer referral appointments than those not screening positive. This could be associated with SDT motivational indices for referral and to linkage factors. This innovative mixed-methods study will inform a needed evidence-base for patients, dental and mental health professionals and other stakeholders, as well as future studies (e.g., a randomized clinical trial) and potential interventions such as Motivational Interviewing strategies to maximize successful referrals.

艾滋病毒/艾滋病感染者在牙科和牙科保健方面没有得到充分的研究和服务。 与一般人群相比，精神卫生服务。PLWHA中的精神和牙科共病 导致诊断复杂性、治疗差距、医疗保健成本增加和结果较差。早期 必须提供诊断和治疗机会。美国没有关于同时发生口腔疾病的研究， 艾滋病毒/艾滋病感染者的精神疾病。对治疗需求的评估、自我管理和病例管理可以 为改善转诊和治疗结果提供信息。研究已经确定了PLWHA的牙科护理障碍， 包括支付能力、牙科焦虑、交通等。患者、艾滋病毒项目主任、病例管理人员和 行政人员是了解艾滋病毒/艾滋病感染者使用牙科和精神卫生服务的关键利益攸关方。他们的 转诊成功率尚未通过传统的艾滋病毒监测进行评估。成功转诊的因素 对艾滋病毒/艾滋病感染者和艾滋病患者的心理健康和牙科服务的研究不足。审查联系因素， 艾滋病毒/艾滋病感染者、方案主任和其他工作人员，包括基于自我决定理论的激励作用 (SDT)机制是必要的。拟议的研究将探讨与艾滋病毒携带者/艾滋病患者转介牙科治疗有关的因素 和精神卫生服务，并描述105例PLWHA中合并症的患病率，他们的自我 管理，以及他们对案件管理的看法。所有患者（有或无合并症）将 评估。主要研究结果是保持牙科和/或心理健康转诊预约。 目的1：在筛查1）口腔疾病的患者中检查转诊联系因素（社会、生物或行为） 仅疾病，2）仅精神疾病，3）口腔疾病和精神疾病，或4）两者都没有（比较 组）。其他评估包括8个关键知情人访谈（KII），2个焦点小组（FG），8-12人 每个参与者和验证的调查。 目的2：2a）描述PLWHA样本中合并症的患病率，自我管理的使用 根据筛查和临床数据（通过唾液传播的牙周炎）， 2b）评估可行性并获得试点数据，以告知未来基于动机的研究。 针对PLWHA的口腔和心理健康行为的干预。 目的3：通过患者筛查、唾液分泌临床检查，检查6个月时的健康状况 生物标志物和一项调查。 假设：牙齿/精神共病筛查阳性的PLWHA将减少转诊预约 而不是筛查阳性。这可能与SDT的转诊动机指数有关， 联系因素。这项创新的混合方法研究将为患者提供所需的证据基础， 和精神卫生专业人员和其他利益相关者，以及未来的研究（例如，一项随机临床 试验）和潜在的干预措施，如动机面试策略，以最大限度地成功转介。