在为 HIV 感染者提供服务的初级保健诊所中实施电子物质使用障碍和抑郁及焦虑筛查及行为干预：促进获得护理参与（PACE）试验方案。
Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial.
机构信息
Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
出版信息
Contemp Clin Trials. 2019 Sep;84:105833. doi: 10.1016/j.cct.2019.105833. Epub 2019 Aug 22.
BACKGROUND
Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care.
METHODS
The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators.
DISCUSSION
The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services.
TRIAL REGISTRATION
NCT03217058.
背景
物质使用障碍（SUD）和精神障碍在 HIV 感染者（PWH）中很常见，导致不良后果。然而，这些情况在初级保健中常常未被识别和治疗。
方法
目前正在进行的促进获得护理参与（PACE）试验研究了自我管理的电子筛查对三个大型 Kaiser Permanente 北加利福尼亚初级保健诊所中 5000 多名 PWH 的 SUD 风险、抑郁和焦虑的影响。筛查使用了经过验证的措施（烟草、酒精、处方药物和其他物质使用[TAPS]；以及成人结果问卷[AOQ]，其中包括患者健康问卷[PHQ-9]和广泛性焦虑障碍[GAD-2]），通过三种方式（安全消息传递、等候室中的平板电脑和检查室中的台式计算机）提供。结果自动集成到电子健康记录中。根据筛查结果和医生转诊，初级保健中嵌入的行为健康专家启动基于动机访谈和认知行为疗法的简短治疗，并根据需要将患者转介到成瘾和精神病诊所。分析使用逐步楔形设计检查实施（筛查和治疗率）和有效性（SUD、抑郁和焦虑症状；HIV 病毒控制）结果，在诊所中依次实施 12 个月的干预阶段，在实施前在每个诊所进行 24 个月的常规护理期作为比较的顺序观察阶段。我们还评估了筛查和治疗成本以及实施障碍和促进因素。
讨论
该研究检验了创新的、技术促进的策略，以改善初级保健中的评估和治疗。结果可能有助于为物质使用、心理健康和 HIV 服务提供信息。
试验注册
NCT03217058。
Zotero 插件