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，尊重患者与提供者的关系对患者的结局至关重要，但我们目前对艾滋病毒/艾滋病和药物滥用治疗中患者与临床医生沟通的理解存在很大差距。最近的一项系统性审查发现，卫生专业人员对物质使用障碍患者的负面态度很常见，并导致医疗保健不佳。在5年的奖励期内要解决的重要问题是，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，特别是那些患有艾滋病毒/艾滋病和药物滥用的患者，这可能导致患者的不尊重和破坏恢复，坚持治疗，保持护理和健康结果的经历。这项研究的长期目标是通过制定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-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，该应用程序的总体目标是建立一个创新的 音频样本库，其可用于前瞻性地区分哪些患者和提供者通信行为对具有当前或过去的物质使用史的患者的结果是重要的。我们的具体目标是（1）建立和维护一个创新的样本库，记录主要艾滋病毒提供者和患者之间的日常接触，作为现有队列研究的一部分，在该研究中，不断评估患者的结局，以及（2）将现有的通信编码方案应用于这些音频记录的遭遇的子集，以理解尊重是如何表现（或不表现）的。通过与患者的日常交流，并使用病例对照设计，以评估特定的沟通行为与患者的结果，如登记和保留在物质使用治疗，坚持抗逆转录病毒治疗，并保留在艾滋病毒护理的关联。通过探索尊重和沟通的复杂性，在物质使用和艾滋病毒/艾滋病的治疗与创新的音频标本库嵌入在一个完善的队列研究，我们将有一个资源，在这个和未来的病例对照研究可以利用迅速发展的沟通分析技术，以确定沟通应改善的领域，评估机制，沟通影响病人的结果，也许最重要的是，将为临床医生制定战略，以加强对吸毒的艾滋病毒感染者的尊重，并改善他们之间的沟通。

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.