Maximizing respect and improving outcomes in HIV and substance abuse (MaRIPOHSA)

最大限度地尊重艾滋病毒和药物滥用并改善其结果 (MaRIPOHSA)

• 批准号: 9037635
• 负责人: MARY CATHERINE BEACH
• 金额: $ 69.85万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9037635
• 关键词: AIDS/HIV problem; Address; Adherence; Alcohol or Other Drugs use; Anti-Retroviral Agents; Area; Attitude; Award; Behavioral; Caring; Case-Control Studies; Code; Cohort Studies; Communication; Counseling; Development; Drug abuse; Drug usage; Educational Intervention; Enrollment; Future; Goals; Guidelines; HIV; Health; Health Professional; Healthcare; Intervention; Lead; Learning; Libraries; Measures; Mediation; Negative Finding; Outcome; Patient-Focused Outcomes; Patients; Pharmacotherapy; Physicians; Provider; Recommendation; Recording of previous events; Recovery; Relationship-Building; Research; Resources; Scheme; Science; Specimen; Substance Use Disorder; Substance abuse problem; Techniques; Testing; Therapeutic; Time; Trust; Viral Load result; antiretroviral therapy; case control; clinical care; communication behavior; design; effective intervention; evidence base; experience; forgetting; health care quality; high risk sexual behavior; improved; improved outcome; innovation; meetings; repository; research study; shared decision making; systematic review; tool; treatment adherence; treatment program

DESCRIPTION (provided by applicant): Despite a well-established evidence base that respectful patient-provider relationships are critically important to patient outcomes, there are wide gaps in our current understanding of patient-clinician communication in the treatment of HIV/AIDS and drug abuse. A recent systematic review finds that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care. The significant problem to be addressed over the 5-year award period is that healthcare professionals do not always communicate effectively and build therapeutic alliance with patients, especially those with HIV/AIDS and drug abuse, which can lead to patients' experiences of disrespect and undermine recovery, adherence to therapy, retention in care, and health outcomes. The long term goal of this research is to improve the quality of HIV care through the development and dissemination of effective interventions to improve respect and patient- provider communication quality. In order to do so, we must develop explicit, practical recommendations and training interventions for clinicians. To take the next step toward meeting this critical need, the overall objective of this application is to establish an innovative audio specimen repository that can be used to distinguish prospectively which patient and provider communication behaviors are important to patient outcomes in those with current or a past history of substance use. Our specific aims are (1) to establish and maintain an innovative specimen repository of audio recorded routine encounters between primary HIV providers and patients as part of an existing cohort study in which patient outcomes are continually assessed, and (2) to apply existing communication coding schemes to a subset of these audio recorded encounters to understand how respect is manifested (or not) through communication with patients in routine encounters and, using a case-control design, to assess the association of particular communication behaviors with patient outcomes such as enrollment and retention in substance use treatment, adherence to ARV therapy, and retention in HIV care. By exploring the complexity of respect and communication in the treatment of substance use and HIV/AIDS with an innovative audio specimen bank embedded in a well-established cohort study, we will have a resource within which this and future case-control studies can utilize rapidly developing communication analysis techniques to identify areas where communication should be improved, evaluate mechanisms by which communication impacts patient outcomes, and perhaps most importantly will develop strategies for clinicians to enhance respect and improve communication among HIV-infected patients with drug abuse.

描述（由申请人提供）：尽管有良好的证据基础表明，尊重的患者支持者对患者的预后至关重要，但我们目前对患者 - 痛苦的艾滋病毒/艾滋病和药物滥用方面的患者 - 智慧沟通的理解却很大。最近的系统评价发现，卫生专业人员对药物使用障碍患者的负面态度很普遍，并有助于次优医疗保健。在5年奖励期间要解决的重大问题是，医疗保健专业人员并不总是有效地沟通，并与患者，尤其是患者，尤其是患者的治疗联盟，尤其是患者的治疗联盟，这可能会导致患者不尊重和破坏康复的经历，遵守治疗，保留治疗，护理中的保留以及健康状况。这项研究的长期目标是通过开发和传播有效的干预措施来提高艾滋病毒护理的质量，以提高尊重和患者提供者的沟通质量。为此，我们必须为临床医生制定明确的，实用的建议和培训干预措施。为了迈出满足这一关键需求的下一步，本申请的总体目标是建立创新的 音频标本存储库可以用来区分哪些患者和提供者的沟通行为对于患者的当前或过去使用史的患者结果很重要。我们的具体目的是（1）建立和维护创新的标本存储库，作为一项现有同类研究的一部分，对初级艾滋病毒提供者和患者之间的音频记录的常规遭遇，不断评估患者的结果，以及（2）将现有的沟通编码方案应用于这些声音记录的习惯（或通过尊重的习惯）的习惯（或者），或者通过对某种审查的方式进行交流（或者），或者是通过尊重的习惯（或者）进行审查（或者通过exportaption exporting of Encorting Acection and conductiate of Score noce exporting A Score nocation of Scroveing A Socection Active and）病例对照设计，以评估特定沟通行为与患者结果的关联，例如入学和保留药物治疗，遵守ARV治疗以及在HIV护理中保留。通过探索嵌入在良好的共同研究中的创新音频库中的尊重和沟通的复杂性，并与创新的音频库嵌入了嵌入在良好建立的队列研究中的创新音调库，我们将拥有一种资源，在该资源中，这项和将来的病例对照研究可以利用迅速发展的沟通分析，以促进沟通的策略，并在该领域中迅速开发沟通，并在其范围内开发策略，并在该领域中促进策略，并在该领域中逐渐发展，并在该领域中发挥作用，并在该领域中发挥了作用。尊重和改善艾滋病毒感染药物滥用的患者的沟通。