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; 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.

项目摘要/摘要 为了响应RFA-MH-20-521 新的处方平台和试点测试这些实施策略，以改善 在Ryan White Care网站中的严重心理健康障碍和酒精滥用障碍（AUD）的药物治疗 结束流行计划的三个县-Dekalb，Gwinnett和Cobb县在亚特兰大都会区。 我们建议参与社区合作委员会（CCB），其中包括艾滋病毒（PLHIV）和 对PLHIV进行深入的访谈，以适应健康政策项目的污名培训以解决 心理健康和与药物滥用有关的污名。我们还将参与精神科医生的专家小组和 艾滋病毒医学专家与提供者进行焦点小组讨论，以告知开发 您的决策规定平台，这将帮助提供者做出有关开处方药的决定 PLHIV中的抑郁症，PTSD，双相情感障碍和AUD。该平台将可以通过移动设备访问 - 智能手机和平板电脑 - 将根据艾滋病毒初级保健的最佳实践使用算法并基于精制 关于艾滋病毒医学和精神病学专家的反馈，以指导艾滋病毒提供者开发最佳 合并症患者的药物治疗方案。对于此计划赠款，我们将使用合并的 实施研究框架，ERIC建议和Proctor的实施分类法 探索实施的决定者，确定实施策略并评估 减少污名培训和评估可行性以及您的决策规定平台的可接受性 积极影响的健康中心，是瑞安白人资助的护理地点。我们还将进行试点试验 评估减少污名培训的初步影响，以减少诊所水平的污名和您的决定 开处方平台，以增加提供者的自我效能感与处方精神药物和 Naltrexone（靶向机制）及其为抑郁症，PTSD，双相情感障碍提供的药物疗法提供 和aud（收养）。具体目的：目标1：与PLHIV，HIV护理提供者进行形成性活动， 以及我们的CCB适应污名培训，以解决与精神健康和药物滥用有关的培训 诊所工作人员之间的污名，并参与艾滋病毒护理提供者和专家小组来制定您的决定 开处方平台支持艾滋病毒护理提供者提供治疗抑郁症的药物治疗，PTSD， 躁郁症和aud。目标2：评估诊所减少污名训练的可接受性 员工以及在使用您的决策规定平台的可行性，可接受性和采用 艾滋病毒护理环境中提供者之间的临床相遇。目的3：使用特学方法进行 试验试验评估污名培训对临床水平污名和污名训练的初步影响 您℞艾滋病毒护理提供者自我效能的决策规定平台，以开处方精神药物 和纳曲酮以及减少污名培训和平台增加百分比的影响 有资格治疗抑郁症，PTSD，双相情感障碍和AUD处方的合格患者。