Technology Enhanced Community Health Nursing to Reduce Recurrent STIs after PID

技术增强社区健康护理以减少 PID 后复发性传播感染

基本信息

批准号：
9092570
负责人：
MARIA E. TRENT
金额：
$ 9.73万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9092570
关键词：
Acute Adherence Adolescent Adolescent and Young Adult Age Attention Baltimore Behavior Caring Cellular Phone Centers for Disease Control and Prevention (U.S.)Clinical Clinical Management Clinical Trials Communication Communities Community Health Nurse Specialist Community Health Nursing Control Groups Cost Control Data Diagnosis Disease Ectopic Pregnancy Educational Curriculum Effectiveness Enrollment Female Adolescents Fertility Health Health Personnel Health Professional Healthcare Hospitalization Infection Infection prevention Infertility Inflammatory Inpatients Intervention Maintenance Medical Medical Care Team Minority Modeling Outcome Outpatients Parents Patients Pelvic Inflammatory Disease Penetration Prevention Protocols Public Health Randomized Randomized Controlled Trials Recurrence Reproductive Health Reproductive Tract Infections Research Research Activity Resources Risk Self Care Self Management Services Sexual Health Sexually Transmitted Diseases Technology Teenagers Text Training Tubal Pregnancy United States Visit Vulnerable Populations Woman Work Youth brief intervention chronic pelvic pain clinical care compare effectiveness cost cost effective cost effectiveness disorder prevention evidence base experience follow-up group intervention health care service utilization high risk improved medication compliance nursing intervention randomized trial reproductive health intervention research clinical testing response screening standard care standard of care treatment strategy trial design young adult young woman

项目摘要

DESCRIPTION (provided by applicant): Pelvic Inflammatory Disease (PID) remains a serious reproductive health disorder and disease rates remain unacceptably high among minority adolescent girls and young adult women. Each episode of this upper reproductive tract infection, usually caused by a sexually transmitted infection (STI), increases the risk for multiple squeal including tubal infertility, ectopic pregnancy, and chronic pelvic pain (CPP). Care for PID has shifted from the inpatient to the outpatient setting; however, our age-stratified analysis of national data shows that adolescents continued to have high rates of repeat STIs and CPP, regardless of treatment strategy. Our local clinical trial data has also shown that urban adolescents have poor adherence to the 3 day clinical follow- up visit recommended by the Centers for Disease Control and Prevention (CDC), are at high risk for STI at the 90-day STI re-screening visit, and that brief interventions in the acute care setting have positive, but modest effects on adherence to self-management behaviors. Inpatient treatment for PID is expensive without incremental increases in effectiveness when compared with outpatient treatment so developing outpatient strategies to improve short and long-term reproductive health outcomes, including recurrent STI and PID, are warranted. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources enhance health care utilization and promote risk-reducing behavior among adolescents. Recent research has also shown that use of short messaging service (SMS) messaging can enhance clinical care by improving attention to medical visits, medication adherence, and communication with the health care team. The primary aim of this project is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N) intervention to an optimized standard of care control group using randomized trial design. We hypothesize that repackaging the recommended CDC-PID follow-up visit using the TECH-N will be cost-effective compared with standard of care and reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse. We have demonstrated that our team of trained community-oriented health professionals can follow adolescent girls with PID in the community and that utilizing CHNs to optimize treatment in the post-PID period is feasible and acceptable to adolescents and parents in urban communities. Our pilot using SMS communication also demonstrates that urban adolescent girls have access to cell phone technology, eagerly accept SMS as a communication strategy, and respond to health provider queries for sexual health maintenance support. We propose to enroll 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive the TECH-N intervention which includes CHN clinical support using a single post-PID face-to-face clinical evaluation that incorporates an evidence based STI prevention curriculum and SMS communication support during the 30-day period following diagnosis (intervention group) or the standard of care (control group).

描述（由申请人提供）：在少数青少年女孩和年轻女性中，骨盆炎症性疾病（PID）仍然是严重的生殖健康疾病和疾病率仍然不可接受。通常由性传播感染（STI）引起的这种上层生殖道感染的每一事件都会增加多种尖叫的风险，包括输管不育症，异位妊娠和慢性骨盆疼痛（CPP）。 PID的护理已从住院转变为门诊设置；但是，我们对国家数据的年龄分层分析表明，无论治疗策略如何，青少年的重复性传播频率和CPP的率仍然很高。我们的本地临床试验数据还表明，城市青少年对疾病控制和预防中心（CDC）建议的为期3天的临床随访依从性较差，在90天的STI重新筛查中，STI的风险很高，并且在急性护理环境中的短暂干预措施对自我管理行为有积极的效果，但对自我管理行为有积极的影响。与门诊治疗相比，对PID的住院治疗却没有增量的效率增加，因此必须制定门诊策略，以改善短期和长期的生殖健康结果，包括经常性STI和PID。已显示社区健康护士（CHN）干预措施可以增加获得适当的资源的机会，从而促进医疗保健利用并促进青少年的降低风险行为。最近的研究还表明，使用短消息服务（SMS）消息传递可以通过提高对医疗访问，药物依从性和与医疗保健团队的沟通的关注来增强临床护理。该项目的主要目的是将技术增强的社区健康护理干预措施（Tech-N）干预与使用随机试验设计的优化护理对照组的有效性进行比较。我们假设，与护理标准相比，重新包装建议使用Tech-N的CDC-PID随访访问将具有成本效益，并通过提高依从性PID治疗并减少未经保护的性交，从而降低短期重复感染的速度。我们已经证明，我们训练有素的受社区卫生专业人员团队可以跟随社区中有PID的青少年女孩，并且利用CHN在PID期间优化治疗是可行的，并且对于城市社区的青少年和父母来说是可接受的。我们使用SMS沟通的飞行员还表明，城市青少年女孩可以使用手机技术，热切地接受SMS作为通信策略，并响应健康提供者的性健康维持支持。我们建议在巴尔的摩诊断为PID的350名年轻女性，并随机将其随机接受，以接受Tech-N干预措施，其中包括使用单一的PID后面对面临床临床评估，其中包括基于证据的STI预防课程，并在诊断后30天（干预组）或对照组（对照组）（对照组）进行了30天的沟通支持。