Working with HIV clinics to adopt addiction treatments using Implementation Facilitation (WHAT IF?)

与艾滋病毒诊所合作，利用实施促进（如果怎样？）

• 批准号: 9054367
• 负责人: David Fiellin
• 金额: $ 39.69万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9054367
• 关键词: Abstinence; Academic Detailing; Address; Administrator; Adopted; Age; Agonist; Alcohol dependence; Alcohols; Anti-Retroviral Agents; Attitude; Behavior; Biological Markers; CD4 Lymphocyte Count; Caring; Cessation of life; Chronic; Clinic; Comorbidity; Consultations; Counseling; Data; Discipline; Discipline of Nursing; Disease; Education; Effectiveness; Emergency Situation; Ensure; Evaluation; Evidence based practice; Evidence based treatment; Feedback; Goals; HIV; Health; Health Benefit; Health Services; Healthcare; Hepatitis C; Hybrids; Immunologics; Individual; Intervention; Kidney; Knowledge; Learning; Life Expectancy; Liver; Marketing; Measures; Medical; Medicine; Mental Health; Methods; Modeling; Monitor; Morbidity - disease rate; Opiate Addiction; Opioid; Organizational Change; Organizational Models; Outcome; Patients; Performance; Pharmaceutical Preparations; Pharmacy facility; Premature Mortality; Primary Health Care; Provider; Psychology; Randomized; Readiness; Research; Risk; Role; Site; Social Work; Substance Use Disorder; System; Tobacco; Tobacco Dependence; Translating; Viral; Viral Load result; Work; addiction; antiretroviral therapy; base; design; evidence base; experience; flexibility; implementation research; implementation science; improved; indexing; mortality; multi-component intervention; novel; parity; preference; programs; public health relevance; skills; tool; uptake

 DESCRIPTION (provided by applicant): Tobacco, alcohol and opioid use disorders threaten the health of HIV-infected patients. What if evidence-based counseling and medication treatments for tobacco, alcohol and opioid use disorders (herein referred to as addiction treatments) were routinely provided in HIV clinics? Implementation Facilitation is an established and reproducible strategy to increase the uptake of evidence-based treatments. It is a multi-component intervention that assesses key stakeholder's (administrators, providers, patients) needs and provides a tailored implementation strategy using an external facilitator, local champions, provider education, academic detailing, stakeholder engagement, performance monitoring and feedback, formative evaluations, learning collaborative and program marketing to implement evidence-based treatments. Our goal is to evaluate the impact of Implementation Facilitation on the use of addiction treatments in four large HIV clinics. We will use the PARiHS (Promoting Action on Research Implementation in Health Services) Implementation Science framework in a Hybrid Type 3 study that allows for simultaneous evaluation of the implementation and its effectiveness. We will use a stepped wedge design that randomly assigns the order in which the clinics receive Implementation Facilitation. Our aims are: Aim 1-Among key stakeholders, to use mixed methods to identify evidence, context and facilitation-related barriers and facilitators to the integration of addiction treatments to help tailor an Implementation Facilitation for each clinic: Aim 2-To assess the impact of Implementation Facilitation on: a) organizational and provider readiness to deliver addiction treatments, b) the provision of addiction treatments, c) changes in organizational models used to deliver addiction treatments; and Aim 3- To evaluate the impact of Implementation Facilitation on antiretroviral receipt, viral suppression, VACS Index (a validated measure of mortality risk) and retention in HIV care among patients eligible for addiction treatment. The novel aspects of this proposal include: 1) the use of Implementation Facilitation to address a range of disorders, rather than a single substance use disorder in HIV clinics, 2) incorporation of administrator, provider and patient input into the implementation of addiction treatment in HIV clinics, 3) a hybrid implementation- effectiveness design for assessing short and long-term uptake of addiction treatments in HIV clinics, 4) a focus on organizational models that ensure that there is integration of addiction treatments at the clinic level but allows flexibility as to who provides these treatments based on stakeholder input and the abused substance, and 5) the use of the VACS Index that better reflects the health benefits of abstinence than a focus on viral load which may be suppressed in patients on antiretroviral treatment despite ongoing tobacco, alcohol or opioid use. The Working with HIV Clinics to adopt Addiction Treatments using Implementation Facilitation (WHAT IF?) study holds exceptional promise of identifying an effective strategy to increasing the uptake of addiction treatments into HIV clinics thereby reversing their devastating impact on morbidity and mortality.

 描述（由应用提供）：烟草，酒精和OOid使用障碍威胁着感染HIV的患者的健康。如果HIV诊所常规提供了针对烟草，酒精和OOid使用障碍（此处称为成瘾治疗的疾病）的循证咨询和药物治疗方法，该怎么办？实施促进是一种既定且可重复的策略，以增加循证治疗的吸收。这是一项多组分干预措施，可以评估主要利益相关者（管理员，提供者，患者）的需求，并使用外部主持人，地方拥护者，提供者教育，学术详细信息，利益相关者的参与，绩效监控和反馈，形成性评估，学习协作和计划营销来实施基于循证的治疗。我们的目标是评估实施方便化对四个大型艾滋病毒诊所使用成瘾治疗的影响。我们将在Hybrid 3型研究中使用Parihs（促进卫生服务研究实施行动）实施科学框架，该研究允许对实施及其有效性进行简单评估。我们将使用阶梯楔形设计，该设计随机分配诊所获得实施便利的顺序。我们的目的是：目标1-凌晨的关键利益相关者，使用混合方法来确定与设施相关的障碍和设施相关的障碍，并协助成瘾治疗的整合，以帮助定制每个诊所的实施促进：目标2来评估实施方案的影响：a）对实施方案的影响：治疗；并瞄准3-评估实施促进物对抗逆转录病毒收据，病毒抑制，VACS指数（对死亡率风险的验证测量）和符合成瘾治疗的患者的HIV护理的影响。该提案的新颖方面包括：1）使用实施促进来解决一系列疾病，而不是艾滋病毒诊所中的单一物质使用障碍，2）纳入管理员，提供者和患者在HIV诊所的实施中的实施，3）在其中进行短期和长期化的企业的实施，以评估HYBRID实施的设计，以评估HIV iniv iniv Istiction a添加HHIV的工作，4在临床水平的成瘾治疗的整合，但可以灵活地基于利益相关者的投入和滥用物质提供这些治疗方法，以及5）使用VACS指数，该INTEX与对病毒负荷的关注更好地反映了对病毒负荷的健康益处，该病毒负荷可能在抗逆转录病毒治疗中受到抗逆转录病毒治疗，尽管正在进行抗过多的毒品治疗，但仍在使用毒素。与艾滋病毒诊所合作，使用实施促进（如果？）研究采用成瘾治疗，这是确定有效策略的非凡希望，以增加成瘾治疗的吸收，从而逆转其对发病率和死亡率的影响。