Addressing Dental and Psychiatric Comorbidities: Screening and Referrals of HIV/AIDS Patients

解决牙科和精神合并症：艾滋病毒/艾滋病患者的筛查和转诊

• 批准号: 10671164
• 负责人: Sangeeta Gajendra
• 金额: $ 19.25万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2025-09-05
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10671164
• 关键词: Address; Administrator; Affect; Appointment; Behavior; Behavioral; Biological; Biological Markers; Caring; Case Management; Case Manager; Climate; Clinic; Clinical Data; Competence; Complex; Data; Dental; Dental Anxiety; Dental Care; Dental Health Services; Dental Insurance; Dentists; Development; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Focus Groups; Foundations; Frequencies; Funding; Future; General Population; Grant; HIV; HIV/AIDS; Health Care Costs; Health Professional; Health Services Accessibility; Health Status; Health behavior; Healthcare; Human Resources; Immune system; Individual; Inflammation; Informal Social Control; Interleukin-6; Intervention; Interview; Measures; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; Motivation; Mouth Diseases; Oral Health Impact Profile; Oral health; Outcome; Outcome Study; Participant; Patients; Perception; Periodontal Diseases; Persons; Population; Prevalence; Prospective Studies; Psyche structure; Questionnaires; Recommendation; Role; Salivary; Sampling; Self Administration; Self Determination; Self Management; Surveys; Transportation; Treatment outcome; Underserved Population; United States National Institutes of Health; clinical examination; comorbidity; comparison group; evidence base; health disparity; health service use; improved; indexing; individual patient; informant; innovation; motivational enhancement therapy; patient population; patient screening; programs; psychiatric comorbidity; randomized, clinical trials; screening; service providers; social; success; theories; tool

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services, compared to the general population. Psychiatric and dental comorbidities in PLWHA result in diagnostic complexities, treatment gaps, increased health care costs and poorer outcomes. Early diagnosis and treatment access are imperative. There are no US studies of co-occurring oral diseases and mental illnesses in PLWHA. Assessment of treatment needs, self-management, and case management can inform improved referral and treatment outcomes. Studies have identified barriers to dental care in PLWHA, including ability to pay, dental anxiety, transportation, etc. Patients, HIV program directors, case managers and administrators are key stakeholders in understanding PLWHA use of dental and mental health services. Their referral success has not been assessed through traditional HIV surveillance. Factors for successful referral of PLWHA to mental health and dental services are understudied. Examining linkage factors as perceived by PLWHA, program directors and other staff, including the role of motivational Self-Determination Theory-based (SDT) mechanisms is needed. The proposed study will examine factors related to referrals of PLWHA to dental and mental health services and to describe the prevalence of comorbidities in 105 PLWHA, their self- management, and their perception of case management. All patients (with or without co-morbidities) will be assessed. The primary study outcome is keeping dental and/or mental health referral appointments. AIM 1: To examine referral linkage factors (social, biological, or behavioral) in those screened for 1) oral diseases only, 2) mental illness only, 3) both oral diseases and mental illness, or 4) neither (comparison group). Other assessments include 8 key informant interviews (KIIs), 2 focus groups (FGs) with 8-12 participants each and validated surveys. AIM 2: 2a) To describe the prevalence of comorbidities in a sample of PLWHA, the use of self-management strategies and their referral need based on screening and clinical data (periodontal inflammation via salivary biomarker IL-6 at baseline); 2b) To assess feasibility and obtain pilot data to inform a future motivation-based intervention targeting oral and mental health behavior in PLWHA. AIM 3: To examine health status at six months via patient screenings, clinical examination with salivary biomarkers, and a survey. Hypothesis: PLWHA screening positive for dental/mental comorbidities will keep fewer referral appointments than those not screening positive. This could be associated with SDT motivational indices for referral and to linkage factors. This innovative mixed-methods study will inform a needed evidence-base for patients, dental and mental health professionals and other stakeholders, as well as future studies (e.g., a randomized clinical trial) and potential interventions such as Motivational Interviewing strategies to maximize successful referrals.

艾滋病毒/艾滋病患者 (PLWHA) 在牙科和艾滋病治疗方面的研究和服务不足 与一般人群相比，心理健康服务。 PLWHA 的精神和牙科合并症 导致诊断复杂性、治疗差距、医疗保健成本增加和结果较差。早期的 诊断和治疗势在必行。美国尚无关于并发口腔疾病的研究 PLWHA 中的精神疾病。评估治疗需求、自我管理和病例管理可以 告知改善转诊和治疗结果。研究已发现 PLWHA 的牙科护理障碍， 包括支付能力、牙科焦虑、交通等。患者、艾滋病毒项目主管、病例经理和 管理者是了解艾滋病病毒感染者使用牙科和心理健康服务的关键利益相关者。他们的 转诊成功与否尚未通过传统的艾滋病毒监测进行评估。成功转介的因素 艾滋病毒感染者对心理健康和牙科服务的研究还不够。检查所感知的联系因素 艾滋病毒感染者、项目主管和其他工作人员，包括基于激励自决理论的作用 需要（SDT）机制。拟议的研究将检查与感染者转诊至牙科诊所相关的因素 和心理健康服务，并描述 105 名 PLWHA 中合并症的患病率，他们的自我 管理，以及他们对案件管理的看法。所有患者（有或没有合并症）都将 评估。主要研究结果是保留牙科和/或心理健康转诊预约。 目标 1：检查筛选对象中的转诊关联因素（社会、生物或行为）：1) 口腔 仅疾病，2) 仅精神疾病，3) 口腔疾病和精神疾病两者，或 4) 两者都不是（比较 团体）。其他评估包括 8 次关键知情人访谈 (KII)、2 个焦点小组 (FG)，其中 8-12 人参加 每个参与者都验证了调查。 目标 2: 2a) 为了描述 PLWHA 样本中合并症的患病率，使用自我管理 基于筛查和临床数据（通过唾液的牙周炎症）的策略及其转诊需求 基线生物标志物 IL-6）； 2b) 评估可行性并获取试点数据，为未来基于动机的方案提供信息 针对 PLWHA 口腔和心理健康行为的干预措施。 目标 3：通过患者筛查、唾液临床检查来检查六个月时的健康状况 生物标志物和一项调查。 假设：PLWHA 牙齿/精神合并症筛查呈阳性将减少转诊预约 比那些未筛查呈阳性的人。这可能与转介和接受 SDT 动机指数有关 联动因素。这项创新的混合方法研究将为患者、牙科患者提供所需的证据基础 和心理健康专业人员和其他利益相关者，以及未来的研究（例如，随机临床 试验）和潜在的干预措施，例如动机访谈策略，以最大限度地提高成功推荐。