Communication Quality and Patient Outcomes in HIV/AIDS and Substance Abuse

 描述（由申请人提供）：这是约翰霍普金斯大学医学院医学博士、公共卫生硕士玛丽凯瑟琳海滩在面向患者的研究中获得K24职业中期研究者奖的提案。海滩博士是韦尔奇预防、流行病学和临床研究中心普通内科和核心学院的医学副教授。在过去的10年里，海滩博士将她的大部分职业生涯和奖学金都花在了以患者为导向的研究上，这些研究针对的是药物滥用（或对药物滥用的看法）流行率高的人群，这些人群对护理质量和健康结果产生了负面影响。尽管有充分的证据表明，高质量的尊重患者与临床医生的沟通和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。最近的一项系统综述确定，患者和咨询师之间的治疗联盟是最重要的预测药物治疗的结果，但很少有人知道如何建立一个治疗联盟之间的医生和患者积极使用药物的医疗环境。该K24奖项将保护申请人指导初级研究人员并进行重要原创研究的时间， 改善临床医生和药物滥用患者之间的沟通和关系。原始研究的目的是：（1）探讨在常规门诊初级艾滋病护理接触中提供者关于药物滥用治疗的咨询质量，确定错过咨询机会的原因，确定更高质量咨询的相关因素，并优先考虑提供者培训的建议，（2）使用会话分析的社会语言学技术，在药物滥用的艾滋病毒感染者的临床治疗中，询问和解决抗逆转录病毒治疗依从性的模式是最可靠和有效的，以及（3）分析音频样本上的音调-记录的遭遇，并检查是否较高水平的尊重和温暖，由独立观察员评价预测持续的病人参与护理艾滋病病毒感染者滥用药物。这些目标将在为新的和现有的初级教师，博士后研究员和学生提供辅导的背景下解决。K24将使海滩博士能够更有效地追求她的长期职业目标，以增强尊重，改善沟通，改善患者的体验，所有这些都是为了减少这些服务不足和被污名化的人群的痛苦，改善他们的健康和福祉。

 DESCRIPTION (provided by applicant): This is a proposal for a K24 Midcareer Investigator Award in Patient-oriented Research for Mary Catherine Beach, MD, MPH of the Johns Hopkins University School of Medicine. Dr. Beach is an Associate Professor of Medicine in the Division of General Internal Medicine and Core Faculty in the Welch Center for Prevention, Epidemiology and Clinical Research. Dr. Beach has spent the majority of her career and scholarship over the past 10 years focusing on patient-oriented research in populations with a high prevalence of substance abuse (or perception of substance abuse) that negatively impacts quality of care and health outcomes. Despite a well- established evidence base that high-quality respectful patient-clinician communication and 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. One recent systematic review determined that therapeutic alliance between patient and counselor was most important in predicting drug treatment outcomes but little is known about how a therapeutic alliance is built in medical settings between physicians and patients with active drug use. This K24 award will protect time for the applicant to mentor junior investigators and conduct significant original research aimed at improving communication and relationships between clinicians and patients with substance abuse. The aims of the original research are: (1) to explore the quality of provider counseling about substance abuse treatment within routine ambulatory primary HIV care encounters, identify reasons for missed opportunities for counseling, identify correlates of higher quality counseling, and prioritize recommendations for provider training, (2) To discover, using the sociolinguistic technique of conversation analysis, which patterns of asking about and addressing anti-retroviral adherence are most reliable and effective in clinical encounters among HIV-infected patients with substance abuse, and (3) to analyze the vocal tone on a sample of audio-recorded encounters and examine whether higher levels of respectfulness and warmth as rated by independent observers predict continued patient engagement in care among HIV-infected patients with substance abuse. These aims will be addressed in the context of providing mentorship to new and existing junior faculty, post-doctoral fellows and students. The K24 will allow Dr. Beach to more effectively pursue her long-term career goals to enhance respect, to improve communication, and to better the patients' experiences, all for the purpose of reducing suffering and improving health and well-being of these underserved and stigmatized populations.