HIV PREVENTION IN PRIMARY CARE--AN OBJECTIVE ASSESSMENT

艾滋病是我们这个时代最重要的健康问题之一。 初级保健提供者对患者的 预防健康行为，并且是适当的卫生专业人员 解决这种疾病的传播问题。医生自我报告、患者报告 对艾滋病毒预防绩效的图表审查表明，这些活动 不是以可接受的速度发生的。然而，这些方法 评估具有固有的不准确性和患者的可变性 演示文稿会影响提供商的绩效。未经宣布的标准化 患者(受过复制临床培训的非专业人员 一致相遇)提供了一种客观的提供者评估方法， 同时控制患者的变异性。它们还允许捕获 提供护理服务的过程(临床护理的顺序和内容 遭遇)，这是使用其他更成熟的方法无法获得的。 这项探索性研究的具体目的是评估、使用 标准化患者(L)艾滋病毒风险的频率和内容 为个人提供的因素确定、教育和咨询 根据他们过去的性史和目前的情况，有接触艾滋病毒的风险 性行为；2)按顺序进行非艾滋病毒预防护理过程 以及风险评估和提供的服务的内容；3) L和2中列出的研究变量的性别和类型的交互作用 标准化患者的提供者和性别；最后，时间和 与临床接触相关的成本。40名小学生的研究样本 护理提供者(20名家庭医生和20名家庭护士从业人员) 将从华盛顿的金县和皮尔斯县中随机挑选 州里。抽样将根据提供者的性别进行分层。每个人 提供者将随机接受男性或女性 在他们的办公室里进行标准化的病人探视。供应商将被蒙在鼓里 评估中的具体研究变量，以及究竟是谁 标准化的患者是什么时候访问将进行到之后 评估期已结束。通过隐藏式麦克风和 将使用记录器验证SP评估的准确性和 临床接触的重复性。卡帕系数将为 计算以评估SP仪器的心理测量学。描述性 统计数据将用于分析研究中的频率和内容 组。按服务提供者的类型和性别以及SP的性别进行比较 用t检验进行检验。会面的简要记录将是 检查提供预防性护理的过程。成绩单将 根据顺序和内容进行编码和分类，并进行比较 将按提供者的类型和性别以及SP的性别进行。这 研究将找出艾滋病毒风险因素确定方面的这两个差距， 预防服务中的咨询、教育和实践优先事项 以及如何按性别、提供者类型和性别进行交付 没有病人。了解初级保健提供者如何组织其 提供预防性保健服务将有助于设计 干预措施，以提高提供者在识别、评估和 满足患者需求。

AIDS is one of the most significant health concerns of our time. Providers in primary care have had a significant impact on patients' preventive health behaviors and are appropriate health professionals to address the spread of this disease. Physician self-report, patient report and chart review of HIV preventive performance indicate these activities are not occurring at an acceptable rate. However, these methods of evaluation have inherent inaccuracies, and variability in patient presentation can influence provider performance. Unannounced standardized patients (lay individuals who have been trained to replicate a clinical encounter consistently) offer an objective method of provider assessment, while controlling for patient variability. They also allow for capturing processes of care delivery (sequence and content of the clinical encounter), which are unobtainable using other more established methods. The specific aims of this exploratory study are to assess, using standardized patients (SP): l) the frequency and content of HIV risk factor determination, education and counseling provided to individuals at risk of HIV exposure based on their past sexual history and current sexual practices; 2) the process of non-HIV preventive care in sequence and content of risk assessment and services delivered; 3) the interactions of study variables listed in l and 2 by gender and type of provider and gender of standardized patient; and lastly, 3) the time and cost associated with clinical encounters. The study sample of 40 primary care providers (20 family physician and 20 family nurse practitioners) will be randomly selected from King and Pierce Counties in Washington State. Sampling will be stratified based on gender of provider. Each provider will be randomized to receive either a male or female standardized patient visit in their office. Providers will be kept blind to the specific study variables under assessment and exactly who the standardized patient is and when the visit will take place until after the evaluation period is over. Audiotaping via hidden microphone and recorder will be used to validate accuracy of SP assessment and reproducibility of clinical encounters. Kappa coefficients will be calculated to assess the psychometrics of the SP instrument. Descriptive statistics will be used to analyze frequency and content within study groups. Comparisons by type and gender of provider and gender of SP will be made using the t-test. Summary transcripts of the encounters will be to examine the process of preventive care delivery. The transcripts will be coded and categorized based on sequence and content, and comparisons will be made by type and gender of provider and gender of SP. This research would identify both gaps in HIV risk factor determination, counseling and education and practice priorities in preventive service delivery and how these may very by gender and type of provider and gender o patient. Understanding how primary care providers organize their delivery of preventive health services will assist in the design of interventions to increase providers' skills in identifying, assessing and addressing patient needs.