Increasing HIV Testing in Inpatient Psychiatry

Shumway, Martha; Mangurian, Christina; N, Carraher; Momenzadeh, Amanda; Leary, Mark R.; Lee, Emily K.; Dilley, James

doi:10.1016/j.psym.2017.10.007

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…Following title and abstract screening, 25 full-text articles were screened for potential inclusion (the remaining articles were primarily excluded due to no use of a clinical champion, or no use of intervention in drug and alcohol or mental health). Eight articles were excluded after full text screening due to insufficient information about clinical champions ( Chang et al, 2013 ; Cohen et al, 2013 ; Kathol et al, 2010 ; Sunderji et al., 2019 ), and use of an intervention not focused on drug and alcohol or mental health treatment ( Banks et al, 2014 ; Bentz et al, 2007 ; Haynes et al, 2011 ; Shumway et al., 2018 ) or in a mental health or drug and alcohol treatment setting ( Ballard et al, 2018 ; Leathers et al., 2016 ; McCabe et al, 2013 ). Two selected studies reported on the same trial ( Hagedorn et al, 2019 ; Harris et al, 2017 ) whereby the Hagedorn et al study is presented here given that it reported on clinical champions although some information was extracted from Harris et al Thirteen (13) articles were included in the final synthesis.…”

Section: Resultsmentioning

confidence: 99%

The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review

Wood

Giannopoulos

Louie

et al. 2020

Implementation Research and Practice

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Background: The dissemination and adoption of research into clinical practice in health care settings is a complex and challenging process. Clinical champions have been increasingly used in health care to facilitate the implementation and adoption of evidence-based practice and to overcome organizational barriers. In relation to substance use and mental health disorders, translation of new evidence into practice is an ongoing challenge. The utilization of a clinical champion to motivate staff to implement evidence-based practice in these settings may improve treatment quality and reduce the burden of disease. We thus aimed to conduct a systematic review to examine the role and efficacy of clinical champions in the drug and alcohol and mental health settings. Methods: We conducted a systematic literature search (1980-present) using the following databases: PubMed and PsycINFO. Additional studies were identified using reference searches of relevant reviews. Results: Thirteen separate studies were included in the final review. Clinical champions were typically selected rather than emergent, including clinical staff members engaging in a professional clinical role (e.g., physicians, psychologists, social workers). Training provided for these roles was often not stated. Clinical champions assisted with faster initiation and persistence in the application of novel interventions, facilitating overcoming system barriers, and enhanced staff engagement and motivation. Conclusions: In the substance use and mental health field, clinical champions appear to be an important component to facilitating practice changes. Future studies should provide specific details regarding attributes and training and also examine the relevant combination of personal characteristics and training sufficient to facilitate implementation of evidence-based practice in drug and alcohol and mental health settings. Plain language abstract Treatment delivery in drug and alcohol and mental health settings may not always be based on best available evidence. Organizational context and individual factors are important in determining whether new practices will be adopted. Passive approaches such as websites or treatment manuals do not necessarily lead to change in practice. The clinical champion model has been shown to be effective in aiding implementation of evidence-based practice in health care settings. However, there is limited evidence evaluating its use in drug and alcohol and mental health settings. The current review aims to synthesize and evaluate the use of clinical champions in implementation research in drug and alcohol and mental health settings. We found that clinical champions were typically clinical staff members engaging in a professional clinical role. Training provided for these roles was often limited. Clinical champions may assist with faster initiation and persistence in the application of novel interventions, facilitating overcoming system barriers, and enhanced staff engagement and motivation.

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Section: Resultsmentioning

confidence: 99%

The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review

Wood

Giannopoulos

Louie

et al. 2020

Implementation Research and Practice

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“…Involuntary patients are frequently unwilling to participate in treatment, and admissions often end abruptly when patients are released against medical advice. 22 As a result, it is frequently challenging to discharge involuntarily admitted patients on a recommended ART regimen. It may be that outpatient primary care is better suited to prescribe ART for many PLWH and people with SMI.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital

et al. 2020

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Background HIV infection is more prevalent among people with severe mental illness (SMI) than in the general population. People with SMI may lack access to recommended antiretroviral therapy (ART), and inpatient psychiatric admissions may be opportunities to ensure that individuals receive recommended treatment. Objective To evaluate ART prescription patterns on an inpatient psychiatry service. Methods In this retrospective, observational study, patient and admission characteristics and ART prescriptions were obtained for 248 HIV-positive inpatients between 2006 and 2012. Receipt of any ART, any recommended ART regimen, and ART with potentially harmful adverse events and drug interactions were examined. General estimating equation models were used to evaluate prescription patterns in relation to patient and admission characteristics. Results ART was prescribed at 39% of discharges and increased by 51% during the study. Prescription was more common in admissions with an AIDS diagnosis and age greater than 29 years and less common in admissions associated with a psychotic diagnosis and shorter inpatient stays. When ART was prescribed, regimens were consistent with guideline recommendations 91% of the time. Prescription of potentially harmful regimens was limited. Conclusion and Relevance In an acute inpatient psychiatry setting in an urban HIV/AIDS epicenter, where psychotic disorders and brief and involuntary admissions were the norm, guideline-recommended ART regimens were prescribed at almost 60% of discharges by the end of the study. Future studies should explore interventions to increase ART for high-risk subpopulations with SMI, including younger individuals or those with brief inpatient psychiatry hospitalizations.

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“…Surveys over the past 2 decades (5-7) found low rates of risk behavior assessment and HIV testing-and of referrals for both-in outpatient mental health settings in New York. Rates of HIV testing in this population are just under 7% (8).…”

mentioning

confidence: 96%

Three Decades and Counting: HIV Service Provision in Outpatient Mental Health Settings

McKinnon

Satriano

Alves-Bradford

et al. 2020

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People with serious mental illness in the United States have higher human immunodeficiency virus (HIV) infection rates than the general U.S. population. This study aimed to assess delivery of HIV services in New York State's outpatient mental health programs. Greater access would enhance efforts to improve HIV prevention and care outcomes. Methods:The authors surveyed directors of licensed outpatient mental health care programs statewide to investigate their HIV service delivery. Data were compared with surveys conducted in 1997 and 2004 in order to examine differences in services between geographic regions and time periods.Results: Outpatient mental health programs have improved in the volume and range of HIV services offered, but their provision of preexposure prophylaxis, condoms, HIV testing, and HIV antiretroviral treatment monitoring has lagged.Conclusions: New York's initiative to end the HIV epidemic is not optimized to reach people with serious mental illness in settings designed for their care.

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Increasing HIV Testing in Inpatient Psychiatry

Abstract: Three interventions of varying intensity were associated with a 5-fold increase in HIV testing on an acute inpatient psychiatry service. Nonetheless, 70% of inpatients were not tested. Continued efforts are needed to increase HIV testing in inpatient psychiatric settings.

Cited by 7 publications

References 22 publications

The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review

The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review

Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital

Three Decades and Counting: HIV Service Provision in Outpatient Mental Health Settings

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