Harnessing telemedicine to improve alcohol use disorder outcomes in primary care patients

利用远程医疗改善初级保健患者酒精使用障碍的结果

• 批准号: 10276367
• 负责人: Erin E. Bonar
• 金额: $ 70.12万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10276367
• 关键词: Abstinence; Address; Adult; Alcohol consumption; Alcohols; COVID-19; COVID-19 pandemic; Caring; Cellular Phone; Chronic; Clinic; Clinical; Cognitive Therapy; Consensus; Evidence based treatment; Goals; Healthcare Systems; Heavy Drinking; Home; Infrastructure; Intervention; Location; Measures; Mediator of activation protein; Medical; Mental Health; Mental disorders; Michigan; Modeling; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patient Care; Patients; Population; Primary Health Care; Provider; Public Health; Quality of life; Randomized; Recovery; Risk; Science; Socioeconomic Status; Strategic Planning; Substance Use Disorder; Telemedicine; Testing; Therapeutic Intervention; Videoconferencing; Work; addiction; alcohol effect; alcohol intervention; alcohol related consequences; alcohol risk; alcohol use disorder; alcohol-related death; care seeking; comparison intervention; design; drinking; effective therapy; efficacy trial; evidence base; experience; follow-up; functional disability; functional improvement; improved; innovation; interest; intervention effect; medical specialties; mortality; motivational enhancement therapy; novel; prevent; psychoeducation; psychosocial; recruit; screening, brief intervention, referral, and treatment; social stigma; treatment as usual

Project Summary/Abstract Alcohol use disorder (AUD) is common and contributes to extensive functional impairments, morbidity and mortality. Evidence-based psychosocial treatments, in particular Cognitive Behavioral Therapies (CBT) and Motivational Interviewing (MI), are effective; but, fewer than 10% of people with AUD receive treatment. Prior efforts have focused on screening, brief intervention and referral to treatment (SBIRT) in primary care. However, referral has failed to increase treatment use due to barriers (e.g., poor treatment accessibility, stigma of specialty addiction clinics) causing referred patients not to seek care. In addition, patients who are typically non-treatment seeking (i.e., patients not presenting for AUD care) may vary in their drinking goals. Thus, new models of care to engage and deliver effective treatments across the spectrum of the large, dispersed population of AUD patients are critically needed. Telemedicine, specifically synchronous videoconferencing between providers and patients in separate locations, can potentially help increase treatment utilization by delivering care to patients at home and reducing stigma of attending treatment in specialty care settings. Telemedicine is effective for many conditions, but there have been no efficacy trials to date for AUD. Although limited telemedicine infrastructure has been a barrier in the past, the COVID-19 pandemic has proven that it can be rapidly implemented and widely used. There is an urgent need to determine if telemedicine delivered AUD treatment is efficacious to inform dissemination. Therefore, the objective of this study is to evaluate a telemedicine-delivered MI-CBT treatment intervention for AUD (MI-CBT TeleTx) compared to Enhanced Usual Care (EUC) on AUD treatment utilization and alcohol use. Primary care patients with AUD in two large healthcare systems in southeast Michigan will be recruited and randomized to either MI-CBT TeleTx or EUC. Specific Aims are: Aim 1: Determine the impact of providing the option of the TeleTx intervention (n=150) compared to EUC (n=150) in primary care patients with AUD on AUD treatment utilization. Aim 2: Determine the efficacy of the TeleTx intervention compared to EUC on percent drinking days and percent heavy drinking days across 3-, 6-, and 12-month follow-ups. Aim 3: Determine the effect of the TeleTx intervention on alcohol-related consequences and functioning (e.g., quality of life, mental health) and the moderating effect of alcohol risk level reductions. In addition, an exploratory aim is to determine key mediators of the effect of intervention on treatment use (through improved treatment accessibility and reduced stigma) and on alcohol use (through treatment use). Impact: The findings from this study will have a significant public health impact as a novel and scalable approach to address the large AUD treatment gap. Further, the work will be the first large efficacy trial of a telemedicine AUD intervention and test a new model of care designed to engage non-treatment seeking patients and deliver effective AUD treatment to patients outside of traditional specialty care settings.

项目摘要/摘要 酒精使用障碍（AUD）很常见，并导致广泛的功能障碍，发病率 和死亡率。基于证据的社会心理治疗，特别是认知行为疗法（CBT） 和动机访谈（MI）是有效的；但是，只有不到10％的AUD患者接受治疗。 先前的努力集中在初级保健中的筛查，简短干预和转诊（SBIRT）上。 但是，转介没有增加由于障碍而增加治疗的使用（例如，治疗可及性不佳，污名化 专业成瘾诊所）导致转诊患者不寻求护理。此外，通常是 寻求未治疗的（即，未参加AUD护理的患者）的饮酒目标可能会有所不同。因此，新的 在大型，分散的范围内参与和提供有效治疗的护理模式 迫切需要AUD患者的人口。 远程医疗，特别是提供者与患者之间的同步视频会议 位置，可以通过在家中提供护理并减少护理来有助于增加治疗利用率 在专业护理环境中参加治疗的污名。远程医疗对许多情况有效，但是 迄今为止，AUD尚无疗效试验。尽管有限的远程医疗基础设施一直是 过去，Covid-19的大流行证明了它可以迅速实施并广泛使用。有一个 迫切需要确定远程医疗提供的AUD处理是否有效地为传播提供信息。 因此，这项研究的目的是评估远程医疗递送的Mi-CBT治疗干预措施 与在AUD治疗利用和饮酒方面增强了常规护理（EUC）相比，AUD（Mi-CBT Teletx）。 将招募密歇根州东南部两个大型医疗保健系统中AUD的初级保健患者，并将被招募 随机分配给Mi-CBT Teletx或EUC。具体目的是： 目标1：确定提供Teletx干预措施（n = 150）的影响 AUD治疗利用率AUD的初级保健患者的EUC（n = 150）。目标2：确定功效 与饮酒百分比的EUC相比，Teletx干预措施和3-3岁的饮酒天数和大量饮酒日百分比 6个月和12个月的随访。 AIM 3：确定Teletx干预对酒精相关的影响 后果和功能（例如，生活质量，心理健康）和酒精风险的调节作用 降低水平。此外，探索目的是确定干预效果的关键调解人 治疗使用（通过改善治疗可及性和减少污名）和饮酒（通过 治疗使用）。影响：这项研究的发现将对新颖的公共卫生产生重大的公共卫生影响，并且 可扩展的方法来解决较大的AUD治疗差距。此外，这项工作将是第一个大型效力试验 远程医疗的AUD干预和测试新的护理模型，旨在参与非治疗 患者并为传统专业护理环境以外的患者提供有效的AUD治疗。