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？）

基本信息

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
项目类别：
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

项目摘要

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（由申请人提供）：烟草、酒精和阿片类药物使用障碍威胁 HIV 感染者的健康如果针对烟草、酒精和阿片类药物使用障碍（本文称为成瘾治疗）常规进行循证咨询和药物治疗会怎样。实施促进是一项既定且可重复的策略，旨在提高循证治疗的采用率。它是一项评估关键利益相关者（管理者、提供者、患者）的需求并提供量身定制的实施策略，利用外部促进者、当地冠军、提供者教育、学术细节、利益相关者参与、绩效监控和反馈、形成性评估、学习协作和项目营销来实施循证治疗的影响。促进在四个大型艾滋病毒诊所使用成瘾治疗的实施我们将在混合 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，该框架允许同时评估我们将使用阶梯式楔形设计，随机分配诊所接受实施促进的顺序。我们的目标是：目标 1 - 在关键利益相关者中，使用混合方法来识别证据、背景和促进相关的障碍。和促进者整合成瘾治疗，以帮助为每个诊所定制实施促进：目标 2-评估实施促进对以下方面的影响：a) 组织和提供者准备提供成瘾治疗，b) 提供成瘾治疗，c) 用于提供成瘾治疗的组织模式的变化；以及目标 3-评估实施促进对抗逆转录病毒治疗、病毒抑制、VACS 指数（死亡风险的有效衡量标准）和患者继续接受艾滋病毒治疗的影响；该提案的新颖之处包括：1) 使用实施促进来解决艾滋病毒诊所中的一系列疾病，而不是单一的药物使用障碍，2) 将管理人员、提供者和患者的意见纳入到治疗中。 HIV 诊所中成瘾治疗的实施，3) 用于评估 HIV 诊所中成瘾治疗的短期和长期接受情况的混合实施效果设计，4) 关注确保诊所整合成瘾治疗的组织模型水平，但允许根据利益相关者的意见和滥用物质灵活地决定由谁提供这些治疗，以及 5) 使用 VACS 指数更好地反映禁欲的健康益处，而不是关注病毒载量，而病毒载量可能在接受抗逆转录病毒治疗的患者中受到抑制尽管正在进行治疗与艾滋病毒诊所合作采用促进实施成瘾治疗（假设是什么？）研究有望确定一种有效的策略，以增加艾滋病毒诊所对成瘾治疗的采用，从而扭转其对发病率的破坏性影响。和死亡率。