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（PLWHA）的人对牙齿和 与普通人群相比，心理健康服务。 PLWHA的精神病和牙科合并症 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 诊断和治疗障碍是必要的。没有美国关于同时发生口腔疾病的研究， PLWHA的精神疾病。评估治疗需求，自我管理和案例管理可以 告知改进的推荐和治疗结果。研究已经确定了PLWHA牙科护理的障碍， 包括支付能力，牙齿焦虑，运输等。患者，艾滋病毒计划董事，案件经理和 管理员是了解牙科和心理健康服务使用PLWHA的关键利益相关者。他们的 转诊成功尚未通过传统的HIV监测来评估。成功推荐的因素 对心理健康和牙科服务的PLWHA进行了研究。检查联系因素所感知的 PLWHA，计划导演和其他员工，包括基于动机的自决作用 （SDT）需要机制。拟议的研究将检查与PLWHA转诊至牙齿有关的因素 和心理健康服务，并描述105 PLWHA合并症的流行，他们的自我 管理及其对案件管理的看法。所有患者（有或没有合并症）将是 评估。主要的研究结果是保持牙科和/或心理健康转诊。 目标1：检查筛选的转介链接因素（社会，生物学或行为）1）口头 仅疾病，仅2）精神疾病，3）口腔疾病和精神疾病，或4） 团体）。其他评估包括8次关键线人访谈（KII），2个焦点小组（FGS），8-12 参与者每个人都验证了调查。 目的2：2a）描述PLWHA样本中合并症的流行，自我管理的使用 策略及其基于筛查和临床数据的转诊需求（唾液牙周炎症 基线时生物标志物IL-6）； 2b）评估可行性并获取飞行员数据以告知未来的基于动机 PLWHA中针对口腔和心理健康行为的干预措施。 目标3：通过患者筛查在六个月时检查健康状况，唾液检查临床检查 生物标志物和调查。 假设：PLWHA筛查对牙科/心理合并症的呈阳性将使更少的推荐约会更少 比不筛选阳性的人。这可能与SDT的推荐和转介指数有关 连锁因素。这项创新的混合方法研究将为患者提供所需的证据库，牙齿 以及精神卫生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，以最大程度地提高推荐。