IMPOVING PHYSICIAN SEXUAL RISK ASSESSMENT/COUNSELING

艾滋病毒和其他性传播疾病造成巨大的损失 在经济资源消耗、人类痛苦方面的社会 造成了伤害，失去了几年的生命。预防是预防的最好手段 遏制性病流行，因为许多人没有治愈方法或疫苗 初级保健医生可以在预防性病方面发挥重要作用 通过评估患者的危险性行为来传播艾滋病毒和其他性传播疾病 并通过提供降低风险咨询。虽然很多人 有声望的组织呼吁医生提供这些 重要的预防服务，许多美国医生目前没有做 所以。试图诱使医生执行性风险评估和 提供降低风险咨询必须满足于普遍的障碍 提供预防性服务和讨论风险的具体障碍 与病人发生性行为。 目前为期四年的研究建议在一项对照的随机试验中 试验，一项为期九个月的密集干预措施，解决了许多 医生执行性风险评估的障碍和 提供降低风险咨询。干预的目的 是提高初级保健医生的技能，这样他们就会 在所有患者都有目标的情况下快速、常规地执行这些任务 来访。初级保健医生将被随机分配到对照组 或试验组。性行为风险的测量 评估和降低风险咨询将在前测、后测、 并进行了九个月的随访。将获得主要结果衡量标准 通过电话采访患者后，与他们的目标访问 医生。在9个月的干预期内， 实验组将收到以实践为导向的时事通讯，将 在医疗病历中插入病历提醒系统 所有接受目标探视的患者，并将参加 以技能为基础的课程，间隔三个月。该课程将包含 讲课，触发录像带，和耐心的指导员进行角色扮演。 该项目有可能显著影响医生的 提供性风险评估和减少风险的做法 心理咨询。通过帮助所有患者了解他们 可能会使自己面临感染性病的风险，这些预防措施 实践可以在遏制艾滋病和其他疾病的传播方面发挥作用 性传播疾病。

HIV and other sexually transmitted diseases exact an enormous toll on society in terms of economic resources expended, human suffering inflicted, and years of life lost. Prevention is the best means for curbing the STD epidemics because there are no cures or vaccines for many STDs Primary care physicians can play an important role in preventing the spread of HIV and other STDs by assessing patients for risky sexual behaviors and by providing risk reduction counseling. Although many prestigious organizations have called for physicians to provide these important preventive services, many US physicians are not currently doing so. Attempts to induce physicians to perform sexual risk assessments and provide risk reduction counseling must content with general barriers to providing preventive services and specific barriers to discussing risky sexual behavior with patients. The present four-year study proposes to test, in a controlled randomized trial, an intensive nine-month intervention that addresses many of the barriers to physicians' performance of sexual risk assessments and provision of risk reduction counseling. The purpose of the intervention is to improve the skills of primary care physicians so that they will perform these tasks quickly and routinely with all patients having target visits. Primary care physicians will be randomly assigned to a control or experimental group. Measurement of performance of sexual risk assessment and risk reduction counseling will occur at pretest, posttest, and nine-month follow-up. The primary outcome measure will be obtained by telephone interviews with patients after target visits with their physicians. During the nine-month intervention period, physicians in the experimental group will receive Practice-oriented Newsletters, will have a Medical Record Reminder System inserted in the medical charts of all patients receiving target visits, and will attend two segments of a Skills-based Course, separated by three months. The course will contain lectures, trigger videotapes, and role playing with patient instructors. This project has the potential to significantly impact physicians' practices in providing sexual risk assessments and risk reduction counseling. By helping all patients understand the ways in which they may be placing themselves at risk of contracting an STD, these preventive practices could play a role in containing the spread of AIDS and other STDs.