Monroe Anne K, Jabour Sarah M, Peña Sebastian, Keruly Jeanne C, Moore Richard D, Chander Geetanjali, Riekert Kristin A
Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, NW, 5th Floor, Room 507, Washington, 20052, USA.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
BMC Health Serv Res. 2018 Jun 7;18(1):419. doi: 10.1186/s12913-018-3203-x.
Inadequate identification and treatment of substance use (SU) and mental health (MH) disorders hinders retention in HIV care. The objective of this study was to elicit stakeholder input on integration of SU/MH screening using computer-assisted patient-reported outcomes (PROs) into clinical practice.
We conducted semi-structured interviews with HIV-positive patients who self-reported SU/MH symptoms on a computer-assisted PROs (n = 19) and HIV primary care providers (n = 11) recruited from an urban academic HIV clinic. Interviews were audio-recorded and transcribed. We iteratively developed codes and organized key themes using editing style analysis.
Two themes emerged: (1) Honest Disclosure: Some providers felt PROs might improve SU/MH disclosure; more were concerned that patients would not respond honestly if their provider saw the results. Patients were also divided, stating PROs could help overcome stigma but that it could be harder to disclose SU/MH to a computer versus a live person. (2) Added Value in the Clinical Encounter: Most providers felt PROs would fill a practice gap. Patients had concerns regarding confidentiality but indicated PROs would help providers take better care of them.
Both patients and providers indicated that PROs are potentially useful clinical tools to improve detection of SU/MH. However, patients and providers expressed conflicting viewpoints about disclosure of SU/MH using computerized PROs. Future studies implementing PROs screening interventions must assess concerns over confidentiality and honest disclosure of SU/MH to understand the effectiveness of PROs as a clinical tool. More research is also needed on patient-centered integration of the results of PROs in HIV care.
物质使用（SU）和心理健康（MH）障碍的识别与治疗不足阻碍了艾滋病病毒（HIV）感染者持续接受治疗。本研究的目的是征求利益相关者对将使用计算机辅助患者报告结局（PROs）进行SU/MH筛查纳入临床实践的意见。
我们对从一家城市学术性HIV诊所招募的自我报告有SU/MH症状的HIV阳性患者（n = 19）和HIV初级保健提供者（n = 11）进行了半结构化访谈。访谈进行了录音和转录。我们使用编辑风格分析迭代地制定编码并组织关键主题。
出现了两个主题：（1）诚实披露：一些提供者认为PROs可能会改善SU/MH的披露；更多人担心如果提供者看到结果，患者不会如实回答。患者也存在分歧，称PROs有助于克服耻辱感，但向计算机披露SU/MH可能比向真人披露更难。（2）临床诊疗中的附加价值：大多数提供者认为PROs将填补实践空白。患者对保密性存在担忧，但表示PROs将有助于提供者更好地照顾他们。
患者和提供者均表示，PROs是改善SU/MH检测的潜在有用临床工具。然而，患者和提供者对于使用计算机化PROs披露SU/MH表达了相互矛盾的观点。未来实施PROs筛查干预措施的研究必须评估对SU/MH保密性和诚实披露的担忧，以了解PROs作为临床工具的有效性。还需要更多关于以患者为中心将PROs结果整合到HIV治疗中的研究。
