Seek, Test, Treat and Retain strategies leveraging mobile health technologies

利用移动医疗技术寻求、测试、治疗和保留策略

• 批准号: 8189772
• 负责人: JAMES S KAHN
• 金额: $ 55.87万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189772
• 关键词: AIDS/HIV problem; Access to Information; Adherence; African American; Anti-Retroviral Agents; Appointment; CD4 Positive T Lymphocytes; Caring; Cellular Phone; Clinic; Clinical; Communication; Communities; Complex; Computers; Cost Analysis; Country; Disadvantaged; Disease; Educational process of instructing; Evaluation; Exclusion; Goals; HIV; HIV Infections; Hair; Health; Health Promotion; Health Technology; Health behavior; Health system; Healthcare; Healthcare Systems; Improve Access; Individual; Information Centers; Information Systems; Information Technology; Injecting drug user; Internet; Intervention; Intervention Studies; Laboratories; Language; Lead; Life; Link; Methods; Newly Diagnosed; Online Systems; Outcome; Patient Education; Patients; Personal Health Records; Persons; Pharmaceutical Preparations; Plasma; Play; Population; Process Assessment; Public Health; RNA; Randomized Controlled Trials; Research Infrastructure; Risk Factors; Role; Sampling; Self Management; Substance Addiction; Substance Use Disorder; Surrogate Markers; Surveys; System; Target Populations; Technology; Testing; Training; Treatment outcome; Trust; Viral; Woman; base; chronic care model; cost effective; cost effectiveness; design; experience; health disparity; health information technology; health literacy; illiteracy; improved; innovation; medication compliance; meetings; novel; rapid diagnosis; safety net; social; tool; transmission process

DESCRIPTION (provided by applicant): Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for a previously unsuspected serious condition and to impact public health by influencing risk factors for transmission. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Internet enabled personal health records (PHRs) provide patients with access to health information, health technology and closer connections to their health systems. Cell phones are another tool for improving connections between patients and their care centers (and for information exchange). Although internet and cellular connections are complementary technologies, cell phones are more accessible to many disadvantaged patients than the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and could play an important role in linking these patients to the health care system. Internet and cellular technologies present new and sustainable opportunities to help AIDS/HIV patients stay in care, especially individuals with co-occurring substance use disorders, with the ultimate goal of improving access to information and providing tools for self-management of their healthcare. In this application we propose an innovation to teach and train newly diagnosed HIV infected individuals to utilize deployed internet and cellular technologies and develop novel applications to assist with linkages to care and improve treatment outcomes. In this project we will determine the impact from patient training in the use of internet and cellular technologies (designed with patient input and built to assist patients self-manage their health) on referrals and follow through with appointments, retention in care and the initiation and sustaining of appropriate antiretroviral treatment. We will utilize developed and deployed technologies that have not been applied previously to the newly identified HIV infected population to determine if internet and cellular technologies improves important biologic, social and health-related outcomes. The target population, newly identified persons with HIV infection receiving care in a safety net setting, meets an additional critical need: to understand how patients in the safety net access and utilize technology tools. Our findings may identify methods to narrow the growing information technology (IT) gap in this country and reduce exclusion of these patients from health-related IT initiatives. Our results will likely inform implementation of Web-based and cellular innovations in other venues. We hypothesize that patients trained and educated to use Web-based and cellular platforms will demonstrate improvements in self-management of healthcare needs, retention in care, and medication adherence, collectively contributing to improved health outcomes. PUBLIC HEALTH RELEVANCE: HIV/AIDS is a serious illness and timely identification of persons with HIV infection followed by the initiation of effective antiretroviral treatment prolongs life and is cost effective. Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for an unsuspected serious condition, and perhaps influence risk factors that contribute to viral spread within a community. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Despite the multiple approaches to treatment there is ample evidence that persons with experiencing health disparities (African-Americans, women and injection drug users) may have poorer access to rapid diagnosis, treatment and problematic adherence and thus have greater HIV health complications. Although internet and cellular connections are complementary technologies, among many disadvantaged patients cell phones are more commonly used than then the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and will be play an important role to link these patients to their health care system. We have implemented the Chronic Care Model in our clinic and placed our emphasis on effective clinical information systems and have shown that the personal health records (PHRs) are a platform for patients to access their clinical information, to communicate with their clinicians and to respond to survey questions. In this application we propose to teach and train newly diagnosed HIV infected individuals to utilize internet and cellular technologies to assist linkages to care and improve outcomes of care. Our findings may identify methods to narrow the growing information technology (IT) gap and reduce exclusion of these patients from health-related IT initiatives.

说明(由申请人提供)：识别、检测、治疗和留住新诊断的艾滋病毒感染者是改善个人健康的重要机会，将他们与以前未被怀疑的严重疾病的护理联系起来，并通过影响传播的风险因素影响公共健康。当新发现的艾滋病毒感染和药物使用障碍患者在安全网环境中接受管理时，他们本已复杂的保健需求因高卫生文盲率和缺乏获得卫生信息的机会而进一步恶化。互联网支持的个人健康记录(PHR)为患者提供了获取健康信息、健康技术和与其健康系统建立更紧密联系的途径。手机是改善患者和他们的护理中心之间联系(以及信息交换)的另一种工具。尽管互联网和蜂窝连接是互补的技术，但许多弱势患者使用手机比互联网更容易获得。因此，这些网络上的蜂窝连接和可用的工具可能被证明对在安全网环境中改善患者的医疗保健至关重要，并可能在将这些患者与医疗保健系统联系起来方面发挥重要作用。互联网和蜂窝技术提供了新的和可持续的机会，帮助艾滋病/艾滋病毒患者继续接受护理，特别是患有药物使用障碍的患者，最终目标是改善获得信息的机会，并为其医疗保健提供自我管理的工具。在这项应用中，我们提出了一项创新，旨在教育和培训新诊断的艾滋病毒感染者利用已部署的互联网和蜂窝技术，并开发新的应用程序，以协助与护理和改善治疗结果的联系。在这个项目中，我们将确定患者在使用互联网和蜂窝技术(根据患者的意见设计，旨在帮助患者自我管理自己的健康)方面的培训对转诊和跟进预约、保留护理以及启动和维持适当的抗逆转录病毒治疗的影响。我们将利用以前没有应用于新发现的艾滋病毒感染人群的开发和部署的技术来确定互联网和细胞技术是否改善了与生物、社会和健康相关的重要成果。目标人群是在安全网环境中接受护理的新发现的艾滋病毒感染者，满足了另一项关键需求：了解安全网中的患者如何获得和利用技术工具。我们的发现可能会确定缩小这个国家日益扩大的信息技术(IT)差距的方法，并减少这些患者被排除在与健康相关的IT倡议之外。我们的结果可能会为在其他场所实施基于网络和蜂窝的创新提供参考。我们假设，接受培训和教育以使用基于网络和蜂窝平台的患者将在医疗需求的自我管理、护理中的保留和服药依从性方面表现出改善，共同有助于改善健康结果。 与公共卫生相关：艾滋病毒/艾滋病是一种严重疾病，及时发现艾滋病毒感染者，然后开始有效的抗逆转录病毒治疗，可延长生命并具有成本效益。识别、检测、治疗和留住新诊断的艾滋病毒感染者是改善个人健康的重要机会，方法是将他们与未被怀疑的严重疾病的护理联系起来，并可能影响导致病毒在社区内传播的风险因素。当新发现的艾滋病毒感染和药物使用障碍患者在安全网环境中接受管理时，他们本已复杂的保健需求因高卫生文盲率和缺乏获得卫生信息的机会而进一步恶化。尽管有多种治疗方法，但有充分证据表明，有健康差距的人(非裔美国人、妇女和注射吸毒者)可能较难获得快速诊断、治疗和有问题的坚持，因此艾滋病毒健康并发症较多。尽管互联网和蜂窝连接是互补的技术，但在许多弱势患者中，手机比互联网更常用。因此，这些网络上的蜂窝连接和可用的工具可能被证明对在安全网环境中改善患者的医疗保健至关重要，并将在将这些患者与其医疗保健系统联系起来方面发挥重要作用。我们已经在我们的诊所实施了慢性护理模式，并将重点放在有效的临床信息系统上，并表明个人健康记录(PHR)是患者获取临床信息、与临床医生交流和回答调查问题的平台。在这项申请中，我们建议教导和培训新诊断的艾滋病毒感染者利用互联网和蜂窝技术来协助与护理的联系，并改善护理结果。我们的发现可能会找到缩小日益扩大的信息技术(IT)差距的方法，并减少这些患者被排除在与健康相关的IT倡议之外。