Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
PLoS One. 2024 Oct 30;19(10):e0312782. doi: 10.1371/journal.pone.0312782. eCollection 2024.
People living with HIV are disproportionately affected by depression, anxiety, and substance use which impede engagement with HIV treatment services and can increase risks of HIV-related morbidity and mortality. Capturing timely, accurate patient data at point of care is recommended to inform clinical decision-making and retain patients on the HIV care continuum. Currently, there is limited use of validated screening tools for substance use and mental health at the point of care in HIV clinics, even though people with HIV (PWH) have a high prevalence of these comorbidities. Even fewer clinics screen in a manner that encourages disclosure of stigmatized substance use, depression, and anxiety. Electronic patient-reported outcomes (ePROs) are an evidence-based modality to overcome such limitations by eliciting responses directly from patients via tablet, smartphone, or computer. To date, there is limited consensus on how to implement ePROs into non-academic settings and enhance uptake. Our team sought to address this gap by examining the implementation of ePROs, previously implemented in an academic clinic, to enhance screening and treatment of mental health (MH) and substance use at five Ryan White HIV/AIDS Program-funded clinics in Alabama. The ePROs were delivered through a multi-component intervention titled HIV + Service delivery and Telemedicine through Effective Patient Reported Outcomes (+STEP), which also provides targeted training to frontline clinicians, and resources for MH and substance use treatment for PWH without access to care. The objective of this study is to provide an implementation blueprint that can be tested and utilized in other HIV clinics to integrate ePROs and increase evidence-based screening for depression, anxiety, and substance use among PWH, as well as outline lessons learned from implementation to date. The findings from this study provide practical steps and advice based on our experience in implementing electronic patient-reported outcomes in HIV clinics in the US Deep South.
受艾滋病毒影响的人群中，抑郁症、焦虑症和药物使用的发生率不成比例，这会妨碍他们参与艾滋病毒治疗服务，增加与艾滋病毒相关的发病率和死亡率。建议在护理点及时、准确地获取患者数据，以便为临床决策提供信息，并使艾滋病毒感染者继续留在艾滋病毒护理连续体中。目前，艾滋病毒诊所护理点很少使用经过验证的药物使用和精神健康筛查工具，尽管艾滋病毒感染者（PLHIV）有这些合并症的高患病率。甚至更少的诊所以鼓励披露被污名化的药物使用、抑郁和焦虑的方式进行筛查。电子患者报告结局（ePROs）是一种基于证据的模式，可以通过平板电脑、智能手机或计算机直接从患者那里获得响应，从而克服这些限制。迄今为止，对于如何将 ePROs 应用于非学术环境并提高其采用率，尚未达成共识。我们的团队通过检查在阿拉巴马州的五个 Ryan White HIV/AIDS 计划资助的诊所中实施 ePROs 之前在学术诊所中实施的情况，来解决这一差距，以增强对心理健康（MH）和药物使用的筛查和治疗。ePROs 通过一个名为 HIV + 服务提供和通过有效的患者报告结果进行远程医疗（+STEP）的多组件干预措施提供，该措施还为一线临床医生提供针对性培训，并为无法获得护理的艾滋病毒感染者提供 MH 和药物使用治疗资源。本研究的目的是提供一个实施蓝图，可以在其他艾滋病毒诊所进行测试和利用，以整合 ePROs，并增加对艾滋病毒感染者中抑郁、焦虑和药物使用的基于证据的筛查，以及概述迄今为止实施过程中的经验教训。本研究的结果提供了基于我们在美国南部实施电子患者报告结果的经验的实用步骤和建议。
