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，尊重的医患关系对患者预后至关重要，但我们目前对艾滋病和药物滥用治疗中医患沟通的理解存在很大差距。最近的一项系统综述发现，卫生专业人员对物质使用障碍患者的消极态度是常见的，并导致次优卫生保健。在5年奖励期内需要解决的重要问题是，医疗保健专业人员并不总是与患者，特别是那些患有艾滋病毒/艾滋病和滥用药物的患者进行有效沟通并建立治疗联盟，这可能导致患者经历不尊重，并破坏康复、坚持治疗、坚持护理和健康结果。这项研究的长期目标是通过发展和传播有效的干预措施来提高艾滋病护理的质量，以提高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

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.