Bluespruce J, Dodge W T, Grothaus L, Wheeler K, Rebolledo V, Carey J W, McAfee T A, Thompson R S
Center for Health Promotion, Group Health Cooperative, Seattle, Washington 98168-2559, USA.
AIDS Patient Care STDS. 2001 May;15(5):243-53. doi: 10.1089/10872910152050766.
Discomfort, lack of confidence in skills, and environmental constraints may cause primary care providers to miss opportunities to discuss human immunodeficiency virus (HIV) risk with patients. We used a systems approach to address both intrapersonal and environmental barriers to HIV risk assessment and prevention counseling in a managed care clinical setting. The design was one-group pretest/posttest. The study took place in two primary care clinics of a large Pacific Northwest managed care organization. Participants (n = 49) included physicians, physician assistants, nurse practitioners, registered nurses, and social workers. The intervention included training, clarification of provider/staff roles, assess to tools and materials, and reminders/reinforcers. Outcome measures were provider attitudes, beliefs, outcome expectations, knowledge, confidence in skills, and perceived supports and barriers, measured by written pretest/posttest surveys administered 12 months apart. Seven months after the most intensive part of the intervention, providers' attitudes and beliefs were more favorable to HIV risk assessment and prevention counseling. They were less likely to express frustration with high-risk patients (decrease from 100% to 79% agreement, p = 0.001) and more confident that their advice would be effective with gay men and single adult heterosexuals (p = 0.002 and 0.005, respectively). They reported more confidence in their training in sexual history taking (p = 0.0003) and their skills assessing readiness for change (p = 0.007), and more support in practice environments. This study demonstrated that it is possible to affect important personal and environmental factors that influence primary care providers' HIV prevention behavior using an interactive, real-world systems approach. Further research is needed on providers' impact on patient behavior.
不适、对自身技能缺乏信心以及环境限制可能导致初级保健提供者错过与患者讨论人类免疫缺陷病毒（HIV）风险的机会。我们采用系统方法来解决管理式医疗临床环境中HIV风险评估和预防咨询的个人内部及环境障碍。研究设计为单组前后测。该研究在太平洋西北部一个大型管理式医疗组织的两家初级保健诊所进行。参与者（n = 49）包括医生、医师助理、执业护士、注册护士和社会工作者。干预措施包括培训、明确提供者/工作人员的角色、提供工具和材料以及提醒/强化措施。通过相隔12个月进行的书面前后测调查来衡量结果指标，包括提供者的态度、信念、结果期望、知识、对技能的信心以及感知到的支持和障碍。在干预最密集阶段后的七个月，提供者对HIV风险评估和预防咨询的态度和信念更为积极。他们对高危患者表达沮丧情绪的可能性降低（同意率从100%降至79%，p = 0.001），并且更有信心他们的建议对男同性恋者和成年单身异性恋者有效（分别为p = 0.002和0.005）。他们表示对性病史询问培训（p = 0.0003）和评估改变意愿的技能（p = 0.007）更有信心，并且在实践环境中得到更多支持。这项研究表明，使用交互式的现实世界系统方法有可能影响影响初级保健提供者HIV预防行为的重要个人和环境因素。关于提供者对患者行为的影响还需要进一步研究。
