Improving Linkages Between Sexual and Reproductive Health and Substance Use Providers: The Partnership to Advance Integrated Referrals.

IF 1.2 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES
Sonya Dublin, Dayana Bermudez, Christina Ortiz, Natalie Tobier, Joslyn Levy, Leah Hargarten
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引用次数: 0

Abstract

Background and objectives: Women of reproductive age with substance use (SU) disorders have lower rates of contraceptive use and higher rates of unintended pregnancy than women without SU disorders and are less likely to access treatment than men. Integration of SU and sexual and reproductive health (SRH) services, using a model known as Screening, Brief Intervention, and Referral to Treatment (SBIRT), has been proven effective in reducing SU and improving health care equity. The SBIRT model includes screening, brief intervention (a short client-centered conversation providing an opportunity to identify/discuss concerns), and referral to treatment. The purpose of this study was to test whether an established quality improvement (QI) learning collaborative model could be used to support SU and SRH sites in implementing an SBIRT/SBIRT-like model to improve health outcomes for women. Five SRH sites and 4 SU sites across New York State participated in the Partnership to Advance Integrated Referrals (PAIR), an 18-month QI learning collaborative designed and implemented by Public Health Solutions.

Methods: Six standardized mixed-methods data collection tools were used over 18 months to gather process and outcome data from over 130 QI team members and site staff and over 5000 clients.

Results: By the end of PAIR, QI team members and site staff showed a reduction in bias, increased knowledge and comfort, increased rating of organizational practices related to client-centered care, and increased access to peer learning, information about best practices, and training and technical assistance. SU sites increased SRH screening from 47.9% in the first quarter of data collection to 67.4% in the final quarter and increased brief interventions from 92.5% in the first quarter to 100.0% in the final quarter. Similarly, SRH sites increased SU screening from 51.6% to 75.6% and increased brief interventions from 81.3% to 85.1%. The processes and outcomes were very different for the SU and SRH sites, and their varying successes and challenges are discussed. Making and verifying referrals remained challenging.

Conclusions: The results of PAIR demonstrated the feasibility of SU and SRH sites implementing an SBIRT/SBIRT-like model when supported by a QI learning collaborative. Larger community and organizational challenges (COVID-19, staff turnover) still present barriers to improved reproductive health and SU outcomes for women.

改善性健康和生殖健康与药物使用提供者之间的联系:促进综合转介的伙伴关系。
背景和目标:与没有药物使用(SU)障碍的女性相比,患有药物使用(SU)障碍的育龄女性的避孕药具使用率较低,意外怀孕率较高,而且与男性相比,她们接受治疗的可能性较低。事实证明,采用筛查、简单干预和转介治疗(SBIRT)模式,将药物滥用与性健康和生殖健康(SRH)服务结合起来,可以有效减少药物滥用并提高医疗保健的公平性。SBIRT 模式包括筛查、简短干预(以客户为中心的简短谈话,提供一个发现/讨论问题的机会)和转介治疗。本研究的目的是检验是否可以利用已建立的质量改进(QI)学习合作模式来支持 SU 和 SRH 机构实施 SBIRT/SBIRT 类模式,以改善妇女的健康状况。纽约州的 5 个 SRH 机构和 4 个 SU 机构参加了 "推进综合转诊合作计划"(PAIR),这是一个由公共卫生解决方案公司设计和实施的为期 18 个月的 QI 学习合作计划:方法:在 18 个月内使用了六种标准化的混合方法数据收集工具,从 130 多名 QI 小组成员和站点工作人员以及 5000 多名客户那里收集过程和结果数据:结果:在 PAIR 结束时,QI 小组成员和医疗点工作人员的偏见减少了,知识和舒适度提高了,对与以客户为中心的护理相关的组织实践的评价提高了,获得同伴学习、最佳实践信息以及培训和技术援助的机会增加了。性健康和生殖健康(SRH)筛查率从数据收集第一季度的 47.9%提高到最后一季度的 67.4%,简短干预率从第一季度的 92.5%提高到最后一季度的 100.0%。同样,性健康和生殖健康医疗点将 SU 筛查从 51.6%提高到 75.6%,将简短干预从 81.3%提高到 85.1%。SU 和 SRH 项目点的过程和结果截然不同,我们将讨论它们不同的成功经验和挑战。结论:PAIR 的结果表明,PAIR 项目的成功与否,直接关系到该项目能否成功实施:PAIR 的结果表明,在 QI 学习合作的支持下,SU 和 SRH 机构实施 SBIRT/SBIRT 类模式是可行的。较大的社区和组织挑战(COVID-19、人员流动)仍是改善妇女生殖健康和 SU 成果的障碍。
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来源期刊
Quality Management in Health Care
Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
1.90
自引率
8.30%
发文量
108
期刊介绍: Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.
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