Multi-site Pilot Trial of Strengths-based Linkage to Alcohol Care (SLAC) for Hazardous Drinkers in Primary Care

针对初级保健中危险饮酒者的基于优势的酒精护理联动 (SLAC) 多地点试点试验

• 批准号: 10312566
• 负责人: Michael Anthony Cucciare
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10312566
• 关键词: Academy; Acute; Address; Age; Alcohol abuse; Alcohol consumption; Alcohols; Area; Behavioral; Caring; Chronic; Clinical; Clinical effectiveness; Counseling; Decision Making; Disease; Effectiveness; Enrollment; Ensure; Evidence based intervention; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; High Prevalence; Hybrids; Improve Access; Intervention; Interview; Knowledge; Lead; Letters; Link; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Methodology; Monitor; Motivation; Outcome; Patients; Population; Post-Traumatic Stress Disorders; Primary Health Care; Provider; Psychologist; Randomized Controlled Trials; Recommendation; Reporting; Risk; Role; Services; Site; Social Workers; Substance Use Disorder; Suicide prevention; Testing; Time; Uncertainty; Veterans; adverse outcome; alcohol screening; alcohol use disorder; barrier to care; base; care providers; care seeking; clinical care; comorbidity; cost outcomes; design; diagnostic criteria; drinking; eHealth; evidence base; follow-up; hazardous drinking; high risk; improved; improved outcome; information gathering; innovation; interest; medical specialties; medication-assisted treatment; meetings; member; military veteran; novel; novel strategies; operation; pilot test; pilot trial; primary care setting; satisfaction; screening; skills; substance use; telephone delivery

Project Summary/Abstract Background: Relatively few Veterans screening positive for hazardous drinking in primary care (PC) receive alcohol care in the year following their alcohol screening. This suggests that existing VHA options for linking Veterans in need of alcohol care, including those with comorbid hazardous drinking and PTSD and/or depression (A-MH), are not effective. To that end, we have identified and propose to pilot test a promising evidence-based intervention, Strengths-based Linkage to Alcohol Care (SLAC). SLAC has the potential to increase linkage to alcohol care, as well as to improve drinking and mental health outcomes, among Veterans with A-MH in PC. Significance: Existing VHA options such as VHA-recommended brief alcohol counseling do not improve linkage to alcohol care, suggesting a critical need for more intensive but practical efforts to link Veterans with A-MH to care. This proposal directly addresses HSR&D priorities in the areas of Access to Care, Mental Health (PTSD), and Primary Care by testing a novel approach (SLAC) to linking Veterans with A-MH to VA and non- VA alcohol care and to improve their drinking and mental health outcomes. Innovation and Impact: The proposed project is highly innovative because it offers a solution to the critical gap in VHA care in which most Veterans in need of alcohol care do not receive it. It tests a strategy to increase linkage to alcohol care that is both intensive enough to produce change, yet feasible to use in busy clinical settings with too-high demand on too-few staff members. A highly innovative feature of SLAC is that it teaches PC providers how to link Veterans with A-MH to alcohol care, which may help normalize conversations about patients’ alcohol use and their care options in PC as part of the provider role. PC providers’ lack of knowledge on how to treat hazardous drinking is a substantial obstacle to Veterans receiving alcohol care. Additional unique and innovative features of SLAC are that it uses patients’ self-identified strengths, abilities, and skills to help them link to an alcohol care option. Specific Aims: Our two aims are (Aim 1): To adapt SLAC for use among Veterans with A-MH and for delivery by telephone in the VHA PC setting. We will conduct qualitative interviews with Veterans, PC staff, and our VACO operational partners to ensure that the content and format of SLAC are adapted so they are relevant and acceptable to these stakeholders. (Aim 2): To determine (a) the feasibility of conducting a larger scale randomized controlled trial (RCT) to test SLAC’s effectiveness and (b) SLAC’s acceptability among Veterans with A-MH in PC, and to explore (c) the efficacy of SLAC in this Veteran population. To achieve Aim 2, we will conduct a multi-site pilot RCT of SLAC at two VA medical facilities (Little Rock, AR and Palo Alto, CA). To achieve Aims 2a-b, we will measure the feasibility (e.g., rates of enrollment and follow-up, fidelity to the SLAC intervention) of conducting a subsequent larger RCT (to test SLAC’s effectiveness) and SLAC’s acceptability (SLAC completion rates, satisfaction with SLAC) among Veterans. To achieve Aim 2c, we will explore the efficacy of SLAC to improve Veterans’ linkage to and utilization of alcohol care, and their alcohol and mental health outcomes, at 3-month follow-up. Methodology: We will use (Aim 1) qualitative interviews to adapt SLAC for Veterans with A-MH and for PC, and (Aim 2) conduct a multi-site, pilot RCT. Debriefing interviews with Veterans will follow the pilot RCT. Next Steps/Implementation: Should our findings justify a subsequent project, we plan to propose a fully powered, multi-site study, using a Hybrid design, to test SLAC’s clinical effectiveness when delivered in VHA PC while observing and gathering information on the implementation potential of SLAC in this setting. Our operations partners are committed to implementing SLAC nationally should it be found to be effective.

项目摘要/摘要 背景：相对较少的退伍军人对初级保健中有害饮酒呈阳性（PC）的退伍军人接受 酒精筛查后的一年酒精护理。这表明现有的链接VHA选项 需要酒精护理的退伍军人，包括那些有危险的饮酒和PTSD和/或 抑郁（A-MH）无效。为此，我们已经确定并提出了试点测试诺言的建议 基于证据的干预，基于优势的与酒精护理（SLAC）的联系。 SLAC有可能 在退伍军人中，增加与酒精护理的联系，以及改善饮酒和心理健康成果 在PC中使用A-MH。 意义：现有的VHA选项（例如VHA推荐的简短酒精咨询）不会改善 与酒精护理的联系，这表明对更密集但实用的努力至关重要，以将退伍军人与 A-MH要照顾。该提案直接解决了获得护理，心理健康领域的HSR＆D优先事项 （PTSD）和初级保健通过测试一种新方法（SLAC）与将A-MH与VA和非 - 的退伍军人联系起来 VA酒精护理并改善他们的饮酒和心理健康结果。 创新和影响：拟议的项目具有很高的创新性，因为它为关键的解决方案提供了解决方案 VHA护理中的差距，大多数需要酒精护理的退伍军人都无法接受。它测试了增加的策略 与酒精护理的联系都足够密集，可以产生变化，但可行，可用于繁忙的临床 对费用太高的工作人员的需求太高。 SLAC的一个高度创新的特征是它教 PC提供商如何将退伍军人与A-MH与酒精护理联系起来，这可能有助于使对话正常化 作为提供者角色的一部分，患者在PC中使用饮酒及其护理选择。 PC提供商缺乏知识 关于如何治疗危险饮酒，这对于接受酒精护理的退伍军人来说是一个巨大的障碍。额外的 SLAC的独特而创新的特征是，它使用患者的自我认同的优势，能力和技能来 帮助他们链接到酒精护理选项。 具体目的：我们的两个目标是（目标1）：调整SLAC以在具有A-MH的退伍军人中使用和交付 通过VHA PC设置中的电话。我们将对退伍军人，PC员工和我们的定性采访 VACO操作合作伙伴，以确保SLAC的内容和格式得到适应，以便它们相关 这些利益相关者可以接受。 （目标2）：确定（a）进行较大规模的可行性 随机对照试验（RCT）测试SLAC的有效性以及（b）SLAC在退伍军人中的可接受性 在PC中使用A-MH，并探索（c）SLAC在这位退伍军人口中的效率。为了实现目标2，我们将 在两个VA医疗设施（Little Rock，AR和CA）进行SLAC的多站点飞行员RCT。到 达到目标2a-b，我们将衡量可行性（例如，入学率和随访率，对SLAC的保真度 干预）进行随后的更大的RCT（测试SLAC的有效性）和SLAC的可接受性 （SLAC完成率，对SLAC的满意度）在退伍军人中。为了达到目标2C，我们将探索 SLAC改善退伍军人与酒精护理的联系和利用的功效以及他们的酒精和精神 健康成果，3个月的随访。 方法论：我们将使用（AIM 1）定性访谈将SLAC适应具有A-MH和PC的退伍军人 （AIM 2）进行多站点的飞行员RCT。与退伍军人的汇报采访将遵循飞行员RCT。 下一步/实施：我们的发现应该证明后续项目是合理的，我们计划完全提出一个 使用混合设计的动力，多站点研究在VHA中进行测试SLAC的临床有效性 PC在观察和收集有关SLAC在此环境中实施潜力的信息时。我们的 如果发现有效，运营伙伴致力于在全国范围内实施SLAC。