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1.
J Behav Health Serv Res ; 46(3): 509-520, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30542903

RESUMO

The objective of this paper was to compare attitudes towards evidence-based practice (EBP) of substance use disorder treatment (SUDT) center employees' serving American Indian and Alaskan Native (AIAN) populations to those serving non-AIAN populations. Survey data on the openness and divergence subscales of the Evidence-Based Practice Attitude Scale (EBPAS) were collected and analyzed. Independent samples T tests were performed to compare the two samples. For all comparisons, except the divergence subscale between counselors, the SUDT employees serving AIANs had significantly lower mean openness scores and higher mean divergence scores than those serving non-AIANs. This study suggests that employees of SUDT centers serving AIAN population hold less positive attitudes towards the adoption and use of EBP than non-AIAN.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Pessoal de Saúde/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Feminino , Humanos , Indígenas Norte-Americanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
Artigo em Inglês | MEDLINE | ID: mdl-29671857

RESUMO

Exposure to trauma is consistently associated with co-occurrence of behavioral health disorders. Primary care settings are opportune places to screen for traumatic experiences and symptoms, as they are often the initial point of care for behavioral health concerns by the Alaska Native and American Indian (AN/AI) population. In this case study, we examine results dissemination activities at the SCF Research Department-hosted 2016 Alaska Native Health Research Forum (Forum) of a pilot study of a trauma-focused screening, brief intervention, and referral to treatment (T-SBIRT) process for AN/AI adults in primary care. Feedback included audience responses to the presentation delivered at the Forum and recommendations to guide future community dissemination of T-SBIRT results. Attendees (N = 31) found the presentation clear, interesting, and included the right amount of detail. Four broad dissemination themes were identified in discussion groups: 1) share results with everyone; 2) share results in ways that reach all AN audiences; 3) provide a summarized status update at each stage of the study; and 4) use results to improve care for trauma and related symptoms.


Assuntos
Pesquisa sobre Serviços de Saúde , Disseminação de Informação , Trauma Psicológico/diagnóstico , Trauma Psicológico/terapia , Humanos , Projetos Piloto , Psicoterapia Breve , Pesquisa Qualitativa , Encaminhamento e Consulta
3.
J Behav Health Serv Res ; 45(1): 31-45, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28236017

RESUMO

Motivational interviewing (MI) offers a treatment modality that can help meet the treatment needs of American Indians/Alaska Natives (AI/ANs) with substance use disorders. This report presents results from a national survey of 192 AI/AN substance abuse treatment programs with regard to their use of MI and factors related to its implementation, including program characteristics, workforce issues, clinician perceptions of MI, and how clinicians learned about MI. Sixty-six percent of programs reported having implemented the use of MI in their programs. In the final logistic regression model, the odds of implementing MI were significantly higher when programs were tribally owned (OR = 2.946; CI95 1.014, 8.564), where more than 50% of staff were Certified Alcohol and Drug Counselors (CADCs) (OR = 5.469; CI95 1.330, 22.487), and in programs in which the survey respondent perceived that MI fit well with their staff's expertise and training (OR = 3.321; CI95 1.287, 8.569).


Assuntos
Atitude do Pessoal de Saúde , Entrevista Motivacional , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Indígenas Norte-Americanos , Masculino , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Local de Trabalho
4.
J Subst Abuse Treat ; 68: 46-56, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27431046

RESUMO

American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time.


Assuntos
Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Prática Clínica Baseada em Evidências , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Indígenas Norte-Americanos , Masculino , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/normas , Centros de Tratamento de Abuso de Substâncias/normas , Serviços de Saúde Suburbana/organização & administração , Serviços de Saúde Suburbana/normas , Serviços Urbanos de Saúde/organização & administração , Serviços Urbanos de Saúde/normas
5.
Drug Alcohol Depend ; 161: 214-21, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-26898185

RESUMO

BACKGROUND: Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes toward, and use of EBTs in substance abuse treatment programs serving AI/AN communities. METHODS: Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes toward, and use of 9 psychosocial and 3 medication EBTs. RESULTS: Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). CONCLUSIONS: EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Indígenas Norte-Americanos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , /psicologia , Humanos , Indígenas Norte-Americanos/psicologia , Indígenas Norte-Americanos/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
6.
Psychol Serv ; 12(2): 92-100, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25961645

RESUMO

Rates of substance abuse remain high in American Indian and Alaska Native (AI/AN) populations. While there are many evidence-based treatments (EBTs) for substance use problems, no studies exist describing how directors of treatment programs serving AI/ANs perceive and use EBTs. Twenty-one key informant interviews with program administrators and 10 focus groups with clinicians were conducted at 18 treatment programs for AI/ANs with substance use problems. Demographic data were not collected to protect participant privacy. Transcripts were coded to identify relevant themes. A majority of participants correctly defined an EBT using the key terms "effective" and "research" found in standard definitions of the phrase. More detailed descriptions were uncommon. Prevalent themes related to attitudes about EBTs included concerns about cultural relevance, external mandates to use EBTs, and their reliance on western conceptualization of substance abuse. While most administrators and clinicians who treat AI/AN clients for substance abuse had a basic understanding of what constitutes an EBT, there was little consensus regarding their relevance for use with AI/ANs. Recognizing that broad geographic and tribal diversity among AI/AN populations may impact conclusions drawn about EBTs, several factors may enhance the abilities of program staff to identify EBTs most appropriate for local implementation. These include gaining a more detailed understanding of how an EBT is developed and how to assess its scientific grounding, as well as utilizing definitions of EBTs that include not only research evidence, but also clinical expertise and judgment, and fit with consumer choice, preference, and culture.


Assuntos
Prática Clínica Baseada em Evidências/normas , Avaliação de Programas e Projetos de Saúde/normas , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Alaska/etnologia , Humanos , Indígenas Norte-Americanos/etnologia , Inuíte/etnologia
7.
Am J Drug Alcohol Abuse ; 38(5): 518-22, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22931088

RESUMO

BACKGROUND: Because of their broad geographic distribution, diverse ownership and operation, and funding instability, it is a challenge to develop a framework for studying substance abuse treatment programs serving American Indian and Alaska Native communities at a national level. This is further complicated by the historic reluctance of American Indian and Alaska Native communities to participate in research. OBJECTIVES AND METHODS: We developed a framework for studying these substance abuse treatment programs (n ≈ 293) at a national level as part of a study of attitudes toward, and use of, evidence-based treatments among substance abuse treatment programs serving AI/AN communities with the goal of assuring participation of a broad array of programs and the communities that they serve. RESULTS: Because of the complexities of identifying specific substance abuse treatment programs, the sampling framework divides these programs into strata based on the American Indian and Alaska Native communities that they serve: (1) the 20 largest tribes (by population); (2) urban AI/AN clinics; (3) Alaska Native Health Corporations; (4) other Tribes; and (5) other regional programs unaffiliated with a specific AI/AN community. In addition, the recruitment framework was designed to be sensitive to likely concerns about participating in research. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This systematic approach for studying substance abuse and other clinical programs serving AI/AN communities assures the participation of diverse AI/AN programs and communities and may be useful in designing similar national studies.


Assuntos
Indígenas Norte-Americanos , Projetos de Pesquisa , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alaska/epidemiologia , Atitude Frente a Saúde , Medicina Baseada em Evidências , Humanos , Seleção de Pacientes , Apoio à Pesquisa como Assunto , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos/epidemiologia
8.
J Med Internet Res ; 7(2): e13, 2005 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-15914460

RESUMO

BACKGROUND: Middle class populations have supported shared medical records, including Internet-accessible medical records. The attitudes of lower income populations, and of physicians, are less clear. OBJECTIVES: The objective of this study was to compare the attitudes toward shared outpatient medical records among (1) socioeconomically disadvantaged patients in community health centers, (2) insured patients in primary care offices, and (3) a broad range of physicians in outpatient practice. METHODS: Written questionnaires were provided to patients in the waiting rooms of six primary care practices in the metropolitan Denver, Colorado area. Three practices were community health centers, and three practices were primary care clinics of an academic medical center. Questionnaires were also mailed to primary care physicians in the state of Colorado. RESULTS: There was a 79% response rate for patient surveys (601 surveys returned) and a 53% response rate for physician surveys (564 surveys returned). Academic medical center patients and community health center patients were equally likely to endorse shared medical records (94% vs 96%) and Internet-accessible records (54% vs 57%). Community health center patients were more likely than academic medical center patients to anticipate the benefits of shared medical records (mean number of expected benefits = 7.9 vs 7.1, P < .001), and they were also somewhat more likely to anticipate problems with shared records. Significant predictors of patient endorsement of Internet-accessible records were previous use of the Internet (OR = 2.45, CI 1.59-3.79), the number of expected benefits (OR = 1.12 per unit, CI 1.03-1.21), anticipation of asking more questions between visits (OR = 1.73, CI 1.18-2.54), and anticipation of finding the doctors' notes to be confusing (OR = 1.50, CI 1.01-2.22). Physicians were significantly more likely than patients to anticipate that access to records would cause problems. Physicians were significantly less likely than patients to anticipate benefits (mean number of expected benefits = 4.2 vs 7.5, P < .001). CONCLUSIONS: Interest in shared medical records is not confined to a white, middle class population. Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are previous experience with the Internet and patients' expectations of the benefits and drawbacks of reading their medical records. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved.


Assuntos
Atitude do Pessoal de Saúde , Atitude , Acesso dos Pacientes aos Registros , Pacientes/psicologia , Médicos/psicologia , Adulto , Idoso , Etnicidade/psicologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Classe Social , Inquéritos e Questionários
9.
Arch Gen Psychiatry ; 61(12): 1197-207, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15583111

RESUMO

BACKGROUND: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort. OBJECTIVE: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders. DESIGN: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants. SETTING: General community. PARTICIPANTS: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%. MAIN OUTCOMES MEASURES: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal. RESULTS: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically. CONCLUSION: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Algoritmos , Estudos Transversais , Erros de Diagnóstico/estatística & dados numéricos , Projetos de Pesquisa Epidemiológica , Estudos Epidemiológicos , Humanos , Indígenas Norte-Americanos/psicologia , Indígenas Norte-Americanos/estatística & dados numéricos , Transtornos Mentais/classificação , Modelos Estatísticos , Valor Preditivo dos Testes , Prevalência , Escalas de Graduação Psiquiátrica/normas , Psicometria , Reprodutibilidade dos Testes , Fatores de Risco , Estudos de Amostragem , Sensibilidade e Especificidade , Terminologia como Assunto , Estados Unidos/epidemiologia
10.
J Med Internet Res ; 6(2): e12, 2004 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-15249261

RESUMO

BACKGROUND: It is possible to provide patients with secure access to their medical records using the Internet. Such access may assist patients in the self-management of chronic diseases such as heart failure. OBJECTIVE: To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff. METHODS: A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored. RESULTS: One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 vs. 85, p=0.08), but was superior in general adherence (MOS compliance score 85 vs. 78, p=0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 vs. 8, p=0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system. CONCLUSIONS: Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.


Assuntos
Insuficiência Cardíaca , Internet/tendências , Sistemas Computadorizados de Registros Médicos/tendências , Sistemas On-Line/tendências , Atenção à Saúde/estatística & dados numéricos , Feminino , Nível de Saúde , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Internet/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistemas On-Line/estatística & dados numéricos , Defesa do Paciente/tendências , Cooperação do Paciente/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Resultado do Tratamento
11.
Med Care ; 42(7): 670-9, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15213492

RESUMO

OBJECTIVE: The objective of this study was to describe the use of biomedical services and traditional healing options among a reservation-based sample of American Indians from 2 culturally distinct tribes METHODS: Participants were 2595 American Indian adolescents and adults ages 15 to 57 randomly selected to represent 2 tribes living on or near their rural reservations. First, we examined the prevalence and correlates of use of biomedical services and traditional healing for both physical health and psychiatric problems. Second, we developed logistic regression models predicting the independent and combined use of biomedical services and traditional healing RESULTS: The prevalence of combined and independent use of biomedical services and traditional healing varied by tribe. The prevalence of biomedical service use ranged from 40.9% to 59.1% for physical health problems and 6.4% to 6.8% for psychiatric problems. The prevalence of the use of traditional healing ranged from 8.4% to 22.9% for physical health problems and 3.2% to 7.8% for psychiatric problems. Although combined use of both types of services was common (10.4-22.6% of service users), many used only traditional healing (3.5-40.0%). Correlates of service use included age, educational level, and ethnic identity. For example, use of traditional healing was correlated with higher scores on a scale measuring identification with American Indian culture CONCLUSIONS: Both biomedical services and traditional healing are important sources of care in American Indian communities, and are used both independently and in combination with one another.


Assuntos
Serviços de Saúde do Indígena/estatística & dados numéricos , Indígenas Norte-Americanos/estatística & dados numéricos , Medicina Tradicional , Adolescente , Adulto , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Indígenas Norte-Americanos/psicologia , Modelos Logísticos , Masculino , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Análise Multivariada , Fatores Socioeconômicos , Sudoeste dos Estados Unidos , Estados Unidos
12.
J Am Med Inform Assoc ; 11(5): 410-7, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15187074

RESUMO

OBJECTIVE: The aim of this study was to evaluate the experiences of patients and physicians in a clinical trial of an online electronic medical record (SPPARO, System Providing Patients Access to Records Online). DESIGN: Quantitative data were obtained from questionnaires. Qualitative data were obtained from individual interviews and focus groups. MEASUREMENTS: Questionnaire items were based on issues identified by patients and physicians in previous studies. Individual interviews and focus groups were performed using a semistructured format developed through an iterative process. RESULTS: Of the eight physicians who participated in the trial, seven completed questionnaires and interviews. Of the 394 patients in the practice, 107 enrolled in the study, and 54 were assigned randomly to the intervention group. Of these, 41 used SPPARO during the trial period. In questionnaires and interviews, patients were significantly more likely than physicians to anticipate benefits of SPPARO and less likely to anticipate problems. Attitudes of subjects did not diverge from controls after the intervention period. In posttrial focus groups, SPPARO users described its practical benefits. Comprehending medical jargon was a minor obstacle. Physicians anticipated that implementing SPPARO might increase their workload and distort their clinical interactions. In posttrial interviews, physicians and staff reported no change in their workload and no adverse consequences. All of the physicians ultimately supported the concept of giving patients online access to their clinical notes and test results. CONCLUSION: SPPARO was useful for a number of patients. Physicians initially voiced a number of concerns about implementing SPPARO, but their experience with it was far more positive.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Insuficiência Cardíaca/terapia , Sistemas Computadorizados de Registros Médicos , Acesso dos Pacientes aos Registros , Feminino , Grupos Focais , Humanos , Masculino , Inquéritos e Questionários
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