The STIRR Intervention for Dually Diagnosed Clients

针对双重诊断客户的 STIRR 干预

• 批准号: 6892531
• 负责人: STANLEY D ROSENBERG
• 金额: $ 60.13万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6892531
• 关键词: AIDS education /prevention; HIV infections; behavioral /social science research tag; clinical research; clinical trials; communicable disease control; community mental health services; comorbidity; health care cost /financing; health care service evaluation; health disparity; health services research tag; hepatitis B; hepatitis B virus group; hepatitis C; hepatitis C virus; high risk behavior /lifestyle; human immunodeficiency virus; human subject; longitudinal human study; medically underserved population; mental disorders; patient oriented research; substance abuse related disorder; urban poverty area

DESCRIPTION (provided by applicant): People with severe mental illness and co-occurring substance abuse disorder are at extremely high risk for HIV, hepatitis B, and hepatitis C. An estimated 1/2 of these dually diagnosed clients test positive for at least one infection, and co-infection, which complicates course and treatment of infection, is also high. Approximately 2/3rds of dually diagnosed clients with HIV are likely to be infected with HCV. Best-practice interventions for blood-borne infections, including screening, testing, immunizing, counseling, and referring to medical specialists could be life-saving for these clients, but they generally do not receive these services. We have developed and pilot tested a brief intervention (STIRR) to provide common basic preventive measures for blood-borne infections to patients with severe mental illness and substance use disorders. Community mental health systems, where clients are most reliably engaged, are not adequately providing these recommended services. The STIRR intervention is based on integrating mental health and other medical care through a public health approach, delivered by nursing and medical specialists, at the site of mental health care. We propose a randomized clinical trial to test STIRR against the usual service model, in which mental health practitioners refer patients directly to other medical providers off site. The proposed RCT will be conducted with an ethnically diverse, inner city sample of low-income clients receiving community based mental health care at two sites in Baltimore, MD, an area of high infection prevalence. Pilot data support the hypothesis that the intervention will prove feasible in typical community mental health settings serving high-risk clients. We hypothesize that clients who receive STIRR, compared to clients receiving treatment as usual, will be more likely to receive screening, testing, immunization, counseling for risk reduction, and appropriate medical care.

描述（由申请人提供）：患有严重精神疾病和同时发生药物滥用障碍的人感染艾滋病毒、乙型肝炎和丙型肝炎的风险极高。估计这些双重诊断的客户中有 1/2 的至少一种检测呈阳性感染和合并感染的比例也很高，这使感染的病程和治疗变得复杂。大约 2/3 的双重诊断 HIV 感染者可能感染 HCV。针对血源性感染的最佳实践干预措施，包括筛查、检测、免疫、咨询和转诊医疗专家，可能会挽救这些客户的生命，但他们通常不会接受这些服务。我们开发并试点测试了一种简短的干预措施（STIRR），为患有严重精神疾病和药物滥用障碍的患者提供血源性感染的常见基本预防措施。客户最可靠参与的社区精神卫生系统没有充分提供这些推荐的服务。 STIRR 干预的基础是通过公共卫生方法整合心理健康和其他医疗护理，由护理和医学专家在心理健康护理现场提供。我们提出了一项随机临床试验，根据通常的服务模式来测试 STIRR，在这种模式中，心理健康从业者将患者直接转介给异地的其他医疗服务提供者。拟议的随机对照试验将针对不同种族的内城区低收入客户样本进行，这些客户在马里兰州巴尔的摩市（感染率较高的地区）的两个地点接受社区心理保健服务。试点数据支持这样的假设：在为高风险客户提供服务的典型社区心理健康环境中，干预措施将被证明是可行的。我们假设，与照常接受治疗的客户相比，接受 STIRR 的客户更有可能接受筛查、检测、免疫、降低风险咨询和适当的医疗护理。