Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting

With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.

Exploring national trends of patient- and family-centered care among US children

We explored national trends in the receipt of high-quality patient–physician communication and patient empowerment through behavioral health counseling among children in the United States. We used data from the Medical Expenditure Panel Survey from 2010 to 2014. We employed two measures of patient- and family-centered care (PFCC): (1) a composite measure of high-quality patient–physician communication ( n = 34,629) and (2) patient empowerment through behavioral health counseling about healthy eating ( n = 36,527) and exercise ( n = 38,318). We used multivariate logistic regression models to estimate the variation of receiving PFCC by social determinants of health over time. Rates of receiving behavioral health counseling about healthy eating (53–60%) and exercise (37–42%) were lower than the rate of receiving high-quality physician–patient communication (92–93%). Parents were significantly more likely to report receiving high-quality physician–patient communication in 2014 than in 2010 (odds ratio 1.37, confidence interval 1.08–1.67); however, no association was found for empowerment through behavioral health counseling. Low income and parental educational attainment, and lack of insurance were associated with lower odds of receiving behavioral health counseling. Results showed significant variation of physician–patient communication and empowerment by social and demographic factors. The results suggest more providers need to empower parents and their children to self-care through behavioral health counseling.

Identifying Prevalence and Characteristics of Behavioral Health Education in Family Medicine Clerkships:

Background and Objectives: Many patients with behavioral health disorders do not seek or receive adequate care for their conditions. Among those that do, most will receive care in a primary care setting. To best meet this need, clinicians will need to demonstrate proficiency of behavioral health skills and evidence-based practices. We sought to explore the degree to which these skills are being taught in family medicine clerkships. Methods: The Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) 2016 survey of clerkship directors (CDs) was sent to 141 CDs at US and Canadian medical schools with a required family medicine run course. CDs were asked about the inclusion of behavioral health topics, tools, and techniques in the clerkship, as well as rating the importance of these items. Results: Eighty-six percent of CDs completed the survey. Mood disorders (81.4%) were most frequently taught, followed by anxiety disorders (77.8%), substance use disorders (74.4%), and impulse control disorders (39.1%). Screening tools and behavioral health counseling skills were less commonly taught. Conclusions: Many behavioral health topics are not taught universally to all family medicine clerkship students. Gaps exist between what is included in current curriculum and what is recommended by the National Clerkship Curriculum for family medicine. These gaps may represent challenges for improving the care for patients with behavioral health disorders.

Frequency of Suicide Ideation and Attempt in HIV infected patients referred to behavioral health counseling center of Rafsanjan (RUMS) and Kerman University of medical sciences (KUMS) in 2012

Background: Suicidal behavior and HIV/AIDS are considered as significant public health concerns. HIV infection has been associated with elevated risk of suicidal ideation.Methods and Materials: Cross-sectional and descriptive research design was used to record socio-demographic data of the study. The suicidal ideation scale BECK was used to determine and measure the frequency of suicide ideation and attempt in HIV infected (HIV+) persons referred to behavioral health counseling center of Rafsanjan University of medical sciences (RUMS) and Kerman University of medical sciences (KUMS) in 2012.Results: Men had more suicidal ideation than women after the diagnosis of infection with HIV. More cases of HIV positive persons with duration of less than 10 and more than 14 years, and most cases of less than 40 years-old had suicidal ideation. There was no significant difference between suicidal ideation in HIV-infected individuals and factors such as gender, age, and duration of HIV-infection (p >0.05). Conclusion: Suicidal ideation and attempt is common in HIV infected patients which needs more assessment and prevention.