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BACKGROUND: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS: In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION: Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.
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Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/terapia , Accesibilidad a los Servicios de Salud/organización & administración , Centros de Tratamiento de Abuso de Sustancias/organización & administración , Trastornos Relacionados con Sustancias/rehabilitación , Adolescente , Adulto , Factores de Edad , Niño , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Salud Global , Infecciones por VIH/complicaciones , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Tamizaje Masivo/organización & administración , Tamizaje Masivo/estadística & datos numéricos , Educación del Paciente como Asunto , Brechas de la Práctica Profesional/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta/organización & administración , Derivación y Consulta/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Desarrollo de Programa , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Illinois , Missouri , Modelos Organizacionales , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto/organización & administración , Educación del Paciente como Asunto/estadística & datos numéricos , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/estadística & datos numéricos , Brechas de la Práctica Profesional/organización & administración , Brechas de la Práctica Profesional/estadística & datos numéricosRESUMEN
We found substantial gaps between preparation for, and practice of, early career family physicians in nearly all clinical practice areas. With reported intentions of graduates for a broad scope of practice, gaps between practice and preparation suggest family physicians early in their careers may not be finding opportunities to provide comprehensive care.