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Impact of a Computer-Assisted SBIRT Program in an HIV Care Setting

计算机辅助 SBIRT 程序在 HIV 护理环境中的影响

基本信息

批准号：
7938696
负责人：
CAROL DAWSON-ROSE
金额：
$ 47.86万
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：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7938696
关键词：
AIDS population AIDS/HIV problem Address African American Alcohol consumption Alcohol or Other Drugs use Alcohols Anti-Retroviral Agents Anus Appointment Area Behavior Behavior assessment Behavioral California Cardiovascular system Caring Cities Clinic Clinical Clinical Research Color Computer Assisted Computerized Medical Record Counseling Data Dependence Disease Doctor of Philosophy Domestic Violence Drug usage Electronic Health Record Electronics Enrollment Future Gays General Hospitals Goals Grant HIV HIV Seropositivity Health Healthcare Hepatitis Illicit Drugs Internet Intervention Latino Life Maintenance Medical Methodology Morbidity - disease rate Online Systems Opioid Analgesics Outcome Participant Patient Care Patient Self-Report Patients Personal Health Records Persons Pharmaceutical Preparations Population Primary Health Care Principal Investigator Protocols documentation Provider Public Health Quality of Care Randomized Randomized Controlled Trials Research Risk Risk Assessment Risk Behaviors San Francisco Screening procedure Self-Administered Severities Smoke Social Workers Structure System Techniques Technology Testing Training United States United States National Institutes of Health Universities Urine Vagina Visit Woman addiction alcohol use disorder antiretroviral therapy arm base brief intervention cohort comparative efficacy design drug testing efficacy trial follow-up health science research high risk improved innovation instrument male medical specialties medication compliance mortality motivational enhancement therapy patient population primary care setting programs public health relevance randomized trial research study screening and brief intervention screening, brief intervention, referral, and treatment sex risk technological innovation therapy adherence tool transmission process treatment program treatment strategy trial comparing

项目摘要

DESCRIPTION (provided by applicant): Impact of a Computer-Assisted SBIRT Program in an HIV Care Setting This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04-DA- 110: Screening, Brief Intervention, and Referral to Treatment. Many studies have demonstrated the relationship between drug/alcohol use in HIV infected patients and morbidity and mortality. Other studies have demonstrated a relationship between drug/alcohol use and high- risk HIV transmission risk behaviors, including unprotected anal and vaginal intercourse with HIV seronegative partners. Even with these documented relationships, however, drug and alcohol use is often not addressed with patients in HIV primary care settings. The screening, brief intervention, and referral to treatment (SBIRT) strategy has been found to be effective in a number of populations, but SBIRT for drug/alcohol use has not been tested in an HIV primary care setting. Therefore, the goal of the proposed project is to assess the impact of SBIRT for harmful alcohol use, illicit drug use, and opioid analgesic use in an HIV primary care setting at San Francisco General Hospital's Positive Health Program (PHP). Specifically, the project aims to examine and compare the feasibility, acceptability and impact of conducting SBIRT through (1) a self-administered, web-based Personal Health Record compared to (2) a provider-administered protocol during clinic appointments. A randomized, two-arm cohort methodology will be used. Three hundred HIV-positive clinic patients will be enrolled, and will receive the SBIRT either through the web-based system (called myHERO), or from a provider with results entered into the electronic medical record system (called HERO). Participants will be seen for four study visits (baseline, 1 Month, 3 Months, 6 Months). SBIRT will be conducted at baseline and at 6 Months. The screening instruments will include the "Alcohol, Smoking and Substance Involvement Screening Test" and "The Alcohol Use Disorders Identification Test." The screening tool scores and interpretation will be added to the Active Problem List in the patient's electronic medical record, and will alert the provider to the need for follow-up. The brief intervention and referral to treatment will be delivered by a clinic- based social worker trained in substance use counseling and motivational interviewing techniques. Participants will be assessed at all four visits for the outcome indicators including alcohol and drug use, HIV transmission risk behaviors, and antiretroviral medication adherence. Enhancing the capacity of the HIV Positive Health Program (PHP) to implement standardized screening for substance use and, when indicated, a systematic approach to brief intervention and referral for more in-depth treatment as needed, has the potential to address preventable health problems among HIV infected clinic patients. More broadly, the project has the potential to reduce morbidity and mortality among HIV-positive people, use technological innovation to improve clinic quality of care, and increase engagement of patients in their own health and healthcare. PUBLIC HEALTH RELEVANCE: Despite research with HIV-positive patients showing relationships between drug/alcohol use and increased morbidity, mortality, and HIV transmission risk behaviors, many HIV primary care providers do not address drug and alcohol use with their patients. The purpose of this study is to test two mechanisms for screening patients for alcohol and drug use, for conducting a brief intervention, and for referring people for specialized care: (1) a web-based personal health record, and (2) a provider-administered protocol during clinic appointments. If these mechanisms are found to be effective, they may reduce morbidity and mortality among HIV-positive patients, and could be adapted for use with other illnesses.

描述(由申请人提供)：计算机辅助SBIRT计划在HIV护理环境中的影响本申请涉及广泛的挑战领域(04)临床研究和特定挑战主题，04-DA-110：筛查、简短干预和转介治疗。许多研究表明，艾滋病毒感染者使用药物/酒精与发病率和死亡率之间存在关系。其他研究已经证明，吸毒/酗酒与高危艾滋病毒传播危险行为之间存在关系，包括与艾滋病毒血清阴性伴侣进行无保护的肛交和阴道性行为。然而，即使有了这些有记录的关系，在艾滋病毒初级保健环境中的患者中，药物和酒精的使用往往也没有得到解决。筛查、短期干预和转诊治疗(SBIRT)策略已被发现在一些人群中有效，但用于药物/酒精使用的SBIRT尚未在艾滋病毒初级保健环境中进行测试。因此，拟议项目的目标是评估SBIRT对旧金山总医院阳性健康计划(PHP)艾滋病毒初级保健环境中有害酒精使用、非法药物使用和阿片类止痛剂使用的影响。具体地说，该项目旨在检查和比较通过(1)自我管理的、基于网络的个人健康记录与(2)在诊所预约期间由提供者管理的协议进行SBIRT的可行性、可接受性和影响。将使用随机的双臂队列方法。300名艾滋病毒阳性的门诊患者将被登记，他们将通过基于网络的系统(称为MyHero)或从提供者那里获得SBIRT，并将结果输入电子医疗记录系统(称为HERO)。参与者将接受四次研究访问(基线、1个月、3个月、6个月)。SBIRT将在基线和6个月时进行。筛查工具将包括“酒精、吸烟和涉及物质的筛查测试”和“酒精使用障碍鉴定测试”。筛查工具的分数和解释将被添加到患者电子病历的活动问题列表中，并将提醒提供者需要跟进。简短的干预和转介治疗将由一名诊所社会工作者提供，他们接受过物质使用咨询和激励性面谈技术方面的培训。参与者将在所有四次检查中接受结果指标的评估，包括酒精和药物使用、艾滋病毒传播危险行为和抗逆转录病毒药物依从性。加强艾滋病毒阳性健康方案实施药物使用标准化筛查的能力，并在需要时采取系统的方法进行简短干预和转诊，以便根据需要进行更深入的治疗，这有可能解决艾滋病毒感染的诊所患者中可预防的健康问题。更广泛地说，该项目有可能降低艾滋病毒阳性者的发病率和死亡率，利用技术创新来提高临床护理质量，并提高患者对自己的健康和医疗保健的参与度。公共卫生相关性：尽管对艾滋病毒阳性患者的研究表明，药物/酒精使用与发病率、死亡率和艾滋病毒传播危险行为的增加之间存在关系，但许多艾滋病毒初级保健提供者没有与他们的患者一起解决药物和酒精使用的问题。这项研究的目的是测试两种机制，用于筛查患者是否酗酒和吸毒，进行简短干预，并转介患者接受专门护理：(1)基于网络的个人健康记录，以及(2)在诊所预约期间由提供者管理的协议。如果这些机制被发现是有效的，它们可能会降低艾滋病毒阳性患者的发病率和死亡率，并可能被改造用于其他疾病。