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

 描述(由申请人提供)：这是为约翰霍普金斯大学医学院公共卫生硕士、医学博士玛丽·凯瑟琳·比奇颁发的以患者为导向研究的K24职业中期研究员奖的提案。比奇博士是韦尔奇预防、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10年里，比奇博士在职业生涯和学术研究中的大部分时间都专注于以患者为中心的研究，研究对象是药物滥用(或对药物滥用的看法)较高的人群，这些药物滥用会对医疗质量和健康结果产生负面影响。尽管有确凿的证据表明，高质量、尊重患者-临床医生的沟通和关系对患者的预后至关重要，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仍存在很大差距。最近的一项系统审查确定，患者和咨询师之间的治疗联盟在预测药物治疗结果方面最重要，但关于医生和积极使用药物的患者之间的治疗联盟是如何在医疗环境中建立的，人们知之甚少。这项K24奖项将保护申请人指导初级调查人员并进行旨在 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)探索在常规的门诊初级艾滋病毒护理接触中关于药物滥用治疗的提供者咨询的质量，找出错过咨询机会的原因，确定更高质量的咨询的相关性，并优先考虑提供者培训的建议，(2)利用对话分析的社会语言学技术，发现在HIV感染的药物滥用患者的临床接触中，询问和解决抗逆转录病毒依从性的哪种模式最可靠和有效，以及(3)分析录音相遇样本的声调，并检查独立观察者评定的较高水平的尊重和温暖是否预示着艾滋病毒感染并滥用药物的患者继续参与护理。这些目标将在为新的和现有的初级教员、博士后研究员和学生提供指导的背景下实现。K24将使比奇博士能够更有效地追求她的长期职业目标，以加强尊重，改善沟通，并改善患者的体验，所有这些都是为了减少痛苦，改善这些服务不足和遭受耻辱的人群的健康和福祉。

 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.