Maximizing respect and improving outcomes in HIV and substance abuse (MaRIPOHSA)

描述(由申请人提供)：尽管有充分的证据表明尊重患者-提供者关系对患者预后至关重要，但我们目前对艾滋病毒/艾滋病和药物滥用治疗中的患者-临床医生沟通的理解存在很大差距。最近的一项系统审查发现，卫生专业人员对药物使用障碍患者的负面态度很常见，并导致次优卫生保健。在5年获奖期内需要解决的重大问题是，医疗保健专业人员并不总是有效地与患者沟通并与患者建立治疗联盟，特别是那些艾滋病毒/艾滋病患者和药物滥用患者，这可能会导致患者经历不尊重，并破坏康复、坚持治疗、护理保留和健康结果。这项研究的长期目标是通过开发和传播有效的干预措施来提高艾滋病毒护理的质量，以改善尊重和患者与提供者的沟通质量。为了做到这一点，我们必须为临床医生制定明确、实用的建议和培训干预措施。为了进一步满足这一关键需求，此应用程序的总体目标是建立一个创新的 音频样本库，可用于前瞻性地区分哪些患者和提供者的沟通行为对那些当前或过去有药物使用史的患者的预后重要。我们的具体目标是(1)建立和维护主要艾滋病毒提供者与患者之间的音频记录例行接触的创新标本库，作为现有队列研究的一部分，其中患者的预后不断被评估，以及(2)将现有的通信编码方案应用于这些音频记录的接触的子集，以了解如何通过在日常接触中与患者的沟通来体现(或不)尊重，并使用病例对照设计，评估特定沟通行为与患者结果的关联，例如在物质使用治疗中的登记和保留、坚持抗逆转录病毒治疗以及在艾滋病毒护理中的保留。通过在一个成熟的队列研究中嵌入一个创新的音频样本库来探索药物使用和艾滋病毒/艾滋病治疗中尊重和沟通的复杂性，我们将拥有一个资源，在其中，这项研究和未来的病例对照研究可以利用快速发展的沟通分析技术来确定沟通应该改进的领域，评估沟通影响患者结局的机制，也许最重要的是将为临床医生制定战略，以加强对艾滋病毒感染的药物滥用患者的尊重和改善沟通。

DESCRIPTION (provided by applicant): Despite a well-established evidence base that respectful patient-provider relationships are critically important to patient outcomes, there are wide gaps in our current understanding of patient-clinician communication in the treatment of HIV/AIDS and drug abuse. A recent systematic review finds that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care. The significant problem to be addressed over the 5-year award period is that healthcare professionals do not always communicate effectively and build therapeutic alliance with patients, especially those with HIV/AIDS and drug abuse, which can lead to patients' experiences of disrespect and undermine recovery, adherence to therapy, retention in care, and health outcomes. The long term goal of this research is to improve the quality of HIV care through the development and dissemination of effective interventions to improve respect and patient- provider communication quality. In order to do so, we must develop explicit, practical recommendations and training interventions for clinicians. To take the next step toward meeting this critical need, the overall objective of this application is to establish an innovative audio specimen repository that can be used to distinguish prospectively which patient and provider communication behaviors are important to patient outcomes in those with current or a past history of substance use. Our specific aims are (1) to establish and maintain an innovative specimen repository of audio recorded routine encounters between primary HIV providers and patients as part of an existing cohort study in which patient outcomes are continually assessed, and (2) to apply existing communication coding schemes to a subset of these audio recorded encounters to understand how respect is manifested (or not) through communication with patients in routine encounters and, using a case-control design, to assess the association of particular communication behaviors with patient outcomes such as enrollment and retention in substance use treatment, adherence to ARV therapy, and retention in HIV care. By exploring the complexity of respect and communication in the treatment of substance use and HIV/AIDS with an innovative audio specimen bank embedded in a well-established cohort study, we will have a resource within which this and future case-control studies can utilize rapidly developing communication analysis techniques to identify areas where communication should be improved, evaluate mechanisms by which communication impacts patient outcomes, and perhaps most importantly will develop strategies for clinicians to enhance respect and improve communication among HIV-infected patients with drug abuse.