Evaluating Practice Facilitation to Optimize Alcohol-Related Care and HCV Treatment Outcomes in HCV Treatment Settings

评估实践便利性以优化 HCV 治疗环境中的酒精相关护理和 HCV 治疗结果

• 批准号: 10290888
• 负责人: Emily Caterina Williams
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10290888
• 关键词: Abstinence; Address; Adherence; Adoption; Affect; Alcohol consumption; Alcohols; Antiviral Agents; Caring; Cause of Death; Chronic; Clinic; Clinical; Clinical effectiveness; Communicable Diseases; Consolidated Framework for Implementation Research; Effectiveness of Interventions; Evaluation; Evidence based practice; Exclusion Criteria; Foundations; Goals; Guidelines; Health; Health Services Accessibility; Heavy Drinking; Hepatitis C Incidence; Hepatitis C Therapy; Hepatitis C virus; Hybrids; Incentives; Interferons; Interruption; Intervention; Interview; Interviewer; Investments; Knowledge; Liver; Logistics; Mental Health; Methodology; Methods; Modeling; Motivation; Naltrexone; Outcome; Patient-Centered Care; Patients; Penetration; Persons; Pharmacotherapy; Provider; Qualitative Methods; Randomized; Reproducibility; Research Priority; Resources; Risk; Secondary to; Series; Services; Structure; Testing; Time; Training; Treatment outcome; United States; Veterans; Virus Diseases; Visit; Vulnerable Populations; Work; addiction; alcohol availability; alcohol intervention; alcohol involvement; alcohol misuse; alcohol use disorder; analytical method; base; behavioral health; brief intervention; design; diagnostic criteria; drinking; effectiveness evaluation; effectiveness implementation design; evidence base; experience; flexibility; health care availability; health care settings; health disparity; implementation facilitation; implementation fidelity; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; liver injury; medical specialties; meetings; military veteran; mortality; patient oriented; patient subsets; response; scale up; secondary outcome; shared decision making; social stigma; substance use; tool; treatment adherence; treatment guidelines; treatment risk

Background. Hepatitis C virus (HCV) is among the most common chronic viral infections in the U.S. and has surpassed all other infectious diseases as a cause of death. With the arrival of highly efficacious directly-acting anti-viral agents, treatment for HCV is now curative for the vast majority of patients. The VA is the largest provider of HCV care in the world and has scaled up efforts to identify and treat HCV. Unhealthy alcohol use is very risky for patients with HCV and influences HCV treatment adherence and outcomes. Despite the risks associated, many patients with HCV drink alcohol at unhealthy levels. While alcohol use was previously a contraindication to treatment, VA guidelines now recommend consideration of treatment for all patients with HCV, including those with unhealthy alcohol use, creating a prime opportunity for co-interventions focused on addressing unhealthy alcohol use during HCV treatment. HCV treatment-typically delivered over multiple visits- may provide time-limited opportunities for delivery of evidence-based alcohol-related interventions, but, due to previous contraindications, clinicians in HCV treatment settings are likely unprepared to offer evidence-based alcohol-related care. Practice facilitation is an effective multilevel implementation strategy that has promise for facilitating provision of alcohol-related care and ultimately improving alcohol use and HCV outcomes among patients with HCV and unhealthy alcohol use. Objective. The proposed study—conducted by a unique team of experts in implementation science and HCV and alcohol-related care—will use practice facilitation to increase provision of evidence-based alcohol-related care in HCV treatment settings and improve alcohol use and HCV treatment outcomes among Veterans with HCV and unhealthy alcohol use. Methods. The study will be guided by the Consolidated Framework for Implementation Research (CFIR) model. In Aim 1, we will use semi-structured qualitative interviewers with key clinical and patient stakeholders and rapid analytic methods to tailor the practice facilitation intervention. In Aims 2 and 3 we will disseminate the tailored intervention to 4 VA clinics in the western U.S. and then apply a Hybrid Type III implementation/ effectiveness design to evaluate the influence of the tailored practice facilitation intervention on implementation (primary) and clinical effectiveness (secondary) outcomes. Five implementation outcomes (acceptability, feasibility, adoption, penetration, and fidelity of alcohol-related care) and three clinical outcomes (alcohol use, HCV treatment completion, and sustained virologic response) will be evaluated using mixed methods. The primary implementation outcome (penetration) and clinical outcomes, will be evaluated using an interrupted time series design in which the implementation intervention is rolled-out in a stepped wedge fashion and clinics serve as their own controls (pre-post). Order in which the clinics receive the intervention will be randomized. Impact. The study is aligned with VA’s cross-cutting research priorities focused on mental and behavioral health, healthcare access, implementation science, and health disparities and with VA’s commitment to providing patient-centered care for unhealthy alcohol use. If effective, the implementation intervention could be scaled throughout VA HCV treatment settings, which could improve health among the vulnerable population of Veterans with HCV and unhealthy alcohol use and may optimize return on VA’s large investment in HCV treatment via reductions in treatment discontinuation and increased cure rates. Moreover, the intervention will help clinicians in VA liver clinics offer alcohol-related care to patients with chronic liver conditions influenced by alcohol use even as the demand for HCV treatment decreases.

背景。丙型肝炎病毒（HCV）是美国最常见的慢性病毒感染之一，已有 作为死亡原因，所有其他传染病都超越了。随着高效直接作用的到来 抗病毒药物，HCV治疗现在已为绝大多数患者治愈。 VA是最大的 世界上HCV护理的提供者，并扩大了识别和治疗HCV的努力。不健康的酒精是 HCV患者的风险很大，并且会影响HCV治疗依从性和结果。尽管有风险 相关的是，许多HCV患者以不健康的水平饮酒。虽然饮酒以前是 治疗禁忌症，VA指南现在建议考虑所有患者 HCV，包括那些不健康的酒精使用的人 解决HCV治疗期间不健康的饮酒。 HCV治疗经常通过多次访问进行交付 - 可能会提供时间有限的机会，以提供基于证据的酒精相关干预措施，但由于 以前的禁忌症，HCV治疗环境中的临床医生可能没有准备好提供基于证据的 与酒精有关的护理。实践促进是一种有效的多层次实施策略，有望 促进提供与酒精有关的护理，并最终改善酒精使用和HCV的结果 HCV和不健康的酒精使用患者。 客观的。拟议的研究 - 由独特的实施科学专家团队和HCV进行了传导 和与酒精有关的护理 - 将使用练习设施来增加基于证据的酒精相关的提供 在HCV治疗环境中的护理，改善与退伍军人的酒精使用和HCV治疗结果 HCV和不健康的酒精使用。 方法。这项研究将由实施研究的合并框架（CFIR）指导 模型。在AIM 1中，我们将与关键临床和患者利益相关者一起使用半结构化定性访调员 和快速分析方法来调整实践设施干预。在目标2和3中，我们将传播 在美国西部的4个VA诊所进行量身定制的干预措施，然后采用III型混合动力/ 有效性设计以评估量身定制的实践设施干预对实施的影响 （初级）和临床有效性（次要）结果。五个实施结果（可接受性， 酒精相关护理的可行性，采用，渗透和保真度）和三个临床结果（酒精使用， HCV治疗的完成和持续的病毒反应将使用混合方法评估。这 主要实施结果（渗透率）和临床结果将使用中断评估 时间序列设计，其中实施干预以阶梯楔形的方式和诊所进行 用作自己的控制（前）。诊所接受干预措施的顺序将随机分组。 影响。该研究与VA的跨切研究重点一致，该研究重点是精神和行为 健康，医疗保健访问，实施科学和健康差异，并承诺 提供以患者为中心的护理不健康的酒精使用。如果有效，则实施干预可能是 在整个VA HCV治疗环境中扩展，这可以改善脆弱人群的健康 HCV和不健康的酒精使用的退伍军人，可以优化VA对HCV的大量投资的回报 通过减少治疗停药和增加治疗率的治疗。而且，干预将 帮助VA肝诊所的临床医生为受酒精相关的护理，为受酒精相关的慢性肝病患者 即使对HCV治疗的需求下降，酒精使用也是如此。

项目成果

Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care.

• DOI: 10.1186/s13722-023-00429-3
• 发表时间: 2024-01-10
• 期刊: ADDICTION SCIENCE & CLINICAL PRACTICE
• 影响因子: 3.7
• 作者: Soyer, Elena M.;Frost, Madeline C.;Fletcher, Olivia V.;Ioannou, George N.;Tsui, Judith I.;Edelman, E. Jennifer;Weiner, Bryan J.;Bachrach, Rachel L.;Chen, Jessica A.;Williams, Emily C.
• 通讯作者: Williams, Emily C.