LINKAGE OF ALCOHOL ABUSERS TO PRIMARY CARE

酗酒者与初级保健的联系

• 批准号: 6168311
• 负责人: JEFFREY H. SAMET
• 金额: $ 23.61万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-05-01 至 2002-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6168311
• 关键词: AIDS education /prevention; HIV infections; alcoholism /alcohol abuse; behavioral /social science research tag; biomedical registry /referral center; clinical research; comprehensive care; detoxification; disease /disorder proneness /risk; health care facility information system; health care service evaluation; health care service utilization; human subject; longitudinal human study; nursing care; outcomes research; primary care physician; psychosocial service; therapy compliance

Alcohol abusers suffer significant health consequences as a result of their substance use, including increased risk for HIV infection, yet they are particularly difficult to engage in primary medical care. Because of this, they often miss opportunities to receive preventive healthcare, including HIV risk reduction interventions, addictions behavioral counseling, prevention of the complications of HIV, and ongoing treatment for illnesses. Substance abuse treatment presents an opportunity to link alcohol abusers to primary medical care. Engaging alcohol abusers with or at-risk of HIV infection in health issues during detoxification may promote their subsequent linkage to primary medical care. This linkage, the addition of primary medical care to their addiction care, may result in more appropriate utilization of HIV and other health services, reduced alcoholism severity, decreased HIV risk behaviors, and improved health status. To test these hypotheses, a cohort of 240 individuals undergoing detoxification from alcohol, including 40 who are HIV-infected (the remaining individuals categorized as at high or low risk for HIV), will be identified and followed for two years. The cohort will be randomized into two groups. One group will receive standard care, including information about available primary care. The other group will attend the Health Evaluation and Linkage to Primary care (HELP) Clinic based at the detoxification unit, which will include a comprehensive medical, substance abuse, and social service assessment, referral to a primary care physician at a site where patients are seen regardless of ability to pay; and nurse contacts to remind them of primary care appointments. To study secondary prevention issues, the study will also enroll and follow a longitudinal cohort of 100 HIV-infected alcohol abusers presenting for initiation of ongoing medical care to the HIV Diagnostic Evaluation Unit at Boston City Hospital. All patients will be assessed at baseline regarding alcohol abuse severity using the alcohol factor score from the Addiction Severity index and the Alcohol Dependence Scale; health status using the EuroQol and the SF-36 Health Survey; and history of high-risk HIV behavior. The subjects will participate in interviews at 6, 12, 18, and 24 months after enrollment. The linkage outcome measure will be connecting to primary care follow-up after enrollment. It is expected that subjects randomized to the HELP Clinic will be more likely to attend visits with a primary care physician. Barriers to primary care and measures of primary care continuity, comprehensiveness and coordination will be documented. We hypothesize that the resultant linkage with primary care will result in improved addiction, health status, and HIV risk behavior outcomes, and more appropriate utilization of medical and addiction treatment services over two years. By establishing the HELP Clinic and rigorously assessing patient outcomes, we plan to determine the efficacy of a specific innovative strategy for linking substance abuse treatment and primary medical care for an alcohol abusing population at risk of HIV or living with HIV infection.

由于酗酒者而遭受重大健康后果 它们的物质使用，包括增加艾滋病毒感染的风险，但 从事初级医疗服务特别困难。 由于 这，他们常常错过获得预防保健的机会， 包括降低艾滋病毒风险干预措施，成瘾行为 咨询，预防艾滋病毒并发症以及正在进行的治疗 疾病。 药物滥用治疗有机会联系 滥用酗酒者。 与饮酒者与或 在排毒期间健康问题中的艾滋病毒感染危险可能 将他们随后与初级医疗保健联系起来。 这个联系， 可能会导致其成瘾护理中的初级医疗保健 在更合适的艾滋病毒和其他卫生服务的利用中，减少了 酒精中毒严重程度，艾滋病毒风险行为降低并改善健康 地位。 为了检验这些假设，由240名个人组成 来自酒精的排毒，包括40位HIV感染的人（ 其余的个人被归类为艾滋病毒的高风险或低风险）将是 确定并遵循两年。 队列将随机分为 两组。 一组将获得标准护理，包括信息 关于可用的初级保健。 另一组将参加健康 评估和与基于初级保健（帮助）诊所的联系 解毒单元将包括全面的医疗物质 滥用和社会服务评估，转介给初级保健医师 在一个看到患者的现场，无论付款能力如何；和护士 联系以提醒他们初级保健约会。 研究次要 预防问题，该研究还将注册并遵循纵向 提出的100个HIV感染的饮酒者的队列 正在进行的医疗服务向波士顿市的HIV诊断评估单位 医院。 所有患者将在基线上对酒精进行评估 使用成瘾严重程度的酒精因子得分的滥用严重程度 指数和酒精依赖量表；使用欧洲的健康状况 和SF-36健康调查；和高风险艾滋病毒行为的历史。 这 受试者将在6、12、18和24个月参加面试 注册。 链接结果度量将连接到主要 注册后的关心随访。 预计受试者是随机的 前往帮助诊所将更有可能与初级访问 护理医师。 初级保健的障碍和初级保健措施 将记录连续性，全面性和协调。 我们 假设由此产生的与初级保健的联系将导致 改善成瘾，健康状况和艾滋病毒风险行为结果，以及 更适当利用医学和成瘾治疗服务 超过两年。 通过建立帮助诊所并严格评估 患者的结果，我们计划确定特定的功效 连接药物滥用治疗和主要的创新策略 滥用艾滋病毒或生命风险的滥用酒精的医疗服务 艾滋病毒感染。