Improving the Integration of Mental Health and Substance Use Treatment into Ryan White-Funded Care Sites in Atlanta using an Implementation Science Approach

使用实施科学方法，将心理健康和药物滥用治疗纳入亚特兰大 Ryan White 资助的护理中心

• 批准号: 10092375
• 负责人: Courtney Peasant Bonner
• 金额: $ 24.4万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092375
• 关键词: AIDS/HIV problem; Address; Adherence; Adoption; Alcohol abuse; Alcohol or Other Drugs use; Algorithms; Area; Attitude; Behavior; Bipolar Disorder; Caring; Cellular Phone; Chronic; Clinic; Communities; County; Decision Making; Development; Diagnosis; Disease; Ensure; Epidemic; Feasibility Studies; Feedback; Focus Groups; Funding; Grant; HIV; Health; Health Policy; Interview; Major Depressive Disorder; Medicine; Mental Depression; Mental Health; Mental disorders; Methods; Naltrexone; Patients; Pharmaceutical Preparations; Pharmacology; Pharmacotherapy; Post-Traumatic Stress Disorders; Prevalence; Primary Health Care; Provider; Psychiatrist; Psychiatry; Public Health; Recommendation; Regimen; Research; Research Priority; Resources; Self Efficacy; Services; Site; Specialist; Stigmatization; Substance abuse problem; Symptoms; Tablets; Taxonomy; Testing; Time; Training; United States; United States National Institutes of Health; Viral; alcohol use disorder; antiretroviral therapy; base; care providers; clinical decision-making; clinical encounter; comorbidity; handheld mobile device; implementation research; implementation science; implementation strategy; improved; pilot trial; response; scale up; social stigma; therapy adherence; transmission process; virology

PROJECT SUMMARY/ABSTRACT In response to RFA-MH-20-521, this R34 application proposes to adapt a stigma-reduction training, develop a new prescribing platform, and pilot test these implementation strategies to improve the integration of pharmacotherapy for serious mental health disorders and alcohol use disorder (AUD) in Ryan White care sites in three counties of the Ending the Epidemic Plan—Dekalb, Gwinnett, and Cobb Counties in the Atlanta Metro area. We propose to engage a Community Collaborative Board (CCB) that includes people living with HIV (PLHIV) and conduct in-depth interviews with PLHIV to adapt the Health Policy Project's stigma-reduction training to address mental health and substance abuse-related stigma. We also will engage an expert panel of psychiatrists and experts in HIV medicine and conduct focus group discussions with providers to inform the development of the You℞ Decision prescribing platform, which will help providers make decisions about prescribing medications for depression, PTSD, bipolar disorder, and AUD among PLHIV. This platform will be accessible via mobile devices— smartphones and tablets—and will use algorithms based on best practices in HIV primary care and refined based on feedback from experts in HIV medicine and psychiatry to guide HIV providers in developing the best medication regimens for patients with comorbid disorders. For this planning grant, we will use the Consolidated Framework for Implementation Research, the ERIC recommendations, and Proctor's implementation taxonomy to explore the determinants of implementation, identify implementation strategies, and assess the acceptability of the stigma-reduction training and assess feasibility and acceptability of the You℞ Decision prescribing platform in Positive Impact Health Centers, which are Ryan White-funded care sites. We will also conduct a pilot trial to assess the preliminary impact of the stigma-reduction training to reduce clinic-level stigma and the You℞ Decision prescribing platform to increase providers' self-efficacy related to prescribing psychiatric medication and naltrexone (targeted mechanisms) and their provision of pharmacotherapy for depression, PTSD, bipolar disorder, and AUD (adoption). Specific Aims: Aim 1: To conduct formative activities with PLHIV, HIV care providers, and our CCB to adapt a stigma-reduction training to address mental health and substance abuse-related stigma among clinic staff and engage HIV care providers and an expert panel to develop the You℞ Decision prescribing platform to support HIV care providers to offer pharmacotherapy to treat depression, PTSD, bipolar disorder, and AUD. Aim 2: To assess the acceptability of the stigma-reduction training among clinic staff and the feasibility, acceptability, and adoption of using the You℞ Decision prescribing platform during clinical encounters among providers in HIV care settings. Aim 3: To use idiographic methods to conduct a pilot trial to assess the preliminary impact of the stigma-reduction training on clinic-level stigma and of the You℞ Decision prescribing platform on HIV care providers' self-efficacy to prescribe psychiatric medications and naltrexone as well as the impact of the stigma-reduction training and platform to increase the percentage of eligible patients who receive prescriptions to treat depression, PTSD, bipolar disorder, and AUD.

项目概要/摘要 为了响应 RFA-MH-20-521，此 R34 申请建议采用减少耻辱培训，开发 新的处方平台，并对这些实施策略进行试点测试，以提高处方的整合度 Ryan White 护理中心针对严重精神健康障碍和酒精使用障碍 (AUD) 的药物治疗 结束流行病计划的三个县——亚特兰大都会区的迪卡尔布县、格威内特县和科布县。 我们建议成立一个社区合作委员会 (CCB)，其中包括艾滋病毒感染者 (PLHIV) 和 对艾滋病病毒感染者进行深入访谈，以调整卫生政策项目的减少耻辱培训，以解决 我们还将聘请精神病和药物滥用专家小组。 艾滋病毒医学专家，并与提供者进行焦点小组讨论，为艾滋病毒治疗的发展提供信息 You℞ 决策处方平台，将帮助提供者做出有关处方药物的决策 艾滋病毒感染者中的抑郁症、创伤后应激障碍 (PTSD)、双相情感障碍和 AUD 将可通过移动设备访问。 智能手机和平板电脑——并将使用基于艾滋病毒初级保健最佳实践的算法和基于改进的算法 根据艾滋病毒医学和精神病学专家的反馈，指导艾滋病毒提供者制定最佳方案 对于合并症患者的药物治疗方案，我们将使用综合补助金。 实施研究框架、ERIC 建议和 Proctor 的实施分类法 探索实施的决定因素，确定实施策略，并评估实施方案的可接受性 减少耻辱培训并评估 You℞ Decision 处方平台的可行性和可接受性 积极影响健康中心，这是瑞安·怀特资助的护理场所，我们还将进行试点试验。 评估减少耻辱感培训的初步影响，以减少诊所层面的耻辱感和 You℞ 决定 处方平台，以提高提供者与精神科药物处方相关的自我效能，以及 纳曲酮（靶向机制）及其为抑郁症、创伤后应激障碍、双相情感障碍提供的药物治疗， AUD（收养）： 目标 1：与 PLHIV、HIV 护理提供者一起开展形成性活动。 和我们的 CCB 进行减少耻辱培训，以解决与心理健康和药物滥用相关的问题 诊所工作人员的耻辱，并让艾滋病毒护理人员和专家小组参与制定 You℞ 决策 支持艾滋病毒护理提供者提供治疗抑郁症、创伤后应激障碍 (PTSD) 的药物疗法的处方平台 双相情感障碍和 AUD 目标 2：评估诊所对减少耻辱感培训的可接受性。 工作人员以及在期间使用 You℞ Decision 处方平台的可行性、可接受性和采用率 目标 3：使用具体方法进行艾滋病毒护理机构中的临床接触。 试点试验旨在评估减少耻辱感培训对诊所级耻辱感的初步影响以及 You℞ 关于艾滋病毒护理人员开出精神科药物的自我效能的决策处方平台 和纳曲酮以及减少耻辱培训和平台对增加百分比的影响 接受治疗抑郁症、创伤后应激障碍、双相情感障碍和 AUD 处方的符合条件的患者。