Implementation Intervention to Improve Care for Unhealthy Alcohol Use

实施干预措施以改善对不健康饮酒的护理

• 批准号: 10535432
• 负责人: Rachel Lauren Bachrach
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10535432
• 关键词: Address; Adoption; Adult; Alcohol consumption; Alcohols; Area; Caring; Centers of Research Excellence; Cessation of life; Chronic Disease; Clinic; Clinical; Clinical Psychology; Consolidated Framework for Implementation Research; Counseling; Criminal Justice; Data; Doctor of Philosophy; Effectiveness; Ensure; Evaluation; Evidence based treatment; Fellowship; Financial cost; Goals; Guidelines; Health; Health Services; Health Services Accessibility; Improve Access; Incentives; Individual; Injury; Intervention; Interview; Investments; Knowledge; Leadership; Link; Measures; Medical; Medical Care Costs; Mental Health; Mentorship; Methodology; Methods; Opioid; Outcome; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Positioning Attribute; Postdoctoral Fellow; Prevention; Preventive care; Primary Care; Provider; Psychologist; Public Health; Qualitative Evaluations; Qualitative Methods; Quality of Care; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; Scientist; Services; Suicide; Suicide prevention; Techniques; Testing; Time; Training; United States Preventative Services Task Force; Veterans; Work; acceptability and feasibility; addiction; adverse outcome; alcohol misuse; alcohol screening; alcohol use disorder; care delivery; career; disability; drinking; effectiveness outcome; effectiveness/implementation trial; evidence base; experience; financial incentive; health care service utilization; health equity; high risk; implementation evaluation; implementation intervention; implementation outcomes; implementation process; implementation science; implementation strategy; improved; innovation; intervention refinement; medical specialties; meetings; mortality; patient screening; pilot test; population based; primary care clinic; primary care provider; primary care setting; process improvement; recruit; screening; societal costs; suicidal; suicidal risk; theories; therapy design; therapy development; tool

Background. Alcohol use is a significant risk factor of disability and death for U.S. adults and one out of every six Veteran seen in primary care (PC) report unhealthy alcohol use. Unhealthy drinking is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA was a pioneer in implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. Approximately 25% of Veterans with unhealthy alcohol use still do not receive BIs and evidence suggests that the quality of BIs is lacking. For those with AUD, BI implementation has not appeared to increase access to recommended services (e.g., referrals) nor reduced barriers to pharmacotherapy. In order to improve the quality and fidelity of alcohol-related care, the current research proposes to use an evidence-based implementation strategy, practice facilitation, at one VA to pilot test whether practice facilitation has the potential to improve quality of PC-based alcohol-related care. Significance/Impact. This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. Thus, this work may have far-reaching effects on adverse outcomes experienced by Veterans and is aligned with top HSRD and VA priorities, including increased access to care and suicide prevention. Innovation. The project will use innovative implementation techniques not previously used to improve VA alcohol-related care. Specific Aims. Aim 1 is a qualitative study assessing Veteran and PC stakeholders to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the practice facilitation intervention. Aim 2 will deliver the practice facilitation intervention in a small PC sample to examine its acceptability and feasibility. Aim 3 is a pilot test of the practice facilitation intervention in the full PC clinic to understand whether practice facilitation improves quality of PC-based alcohol-related care. Methodology. Aim 1 will recruit and interview Veterans with unhealthy alcohol use (n=20-25) and PC stakeholders (N=10-15) to help refine the practice facilitation. Aim 2 will deliver the practice facilitation among a small sample of PC providers and staff (n=5-7) to assess acceptability/feasibility. In Aim 3, PC providers/staff from the full clinic will be invited to participate in the practice facilitation in order to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes. Implementation/Next Steps. Findings will be presented to local and national operational partners and used to improve evidence-based alcohol-related care nationally across VA PC. Candidate. Dr. Rachel Bachrach is a clinical psychologist and postdoctoral research fellow in the Interprofessional Advanced Fellowship in Addiction Treatment based within the Center for Health Equity Research and Promotion (CHERP), a VA HSR&D Research Center of Excellence. The purpose of this CDA-2 is to facilitate Dr. Bachrach’s transition to an independent HSR&D investigator with a long-term objective of improving evidence-based care for addictive disorders. The short-term objective is to obtain formal training, expert mentorship, and research experience to facilitate a VA HSR&D career focused on improving prevention and intervention efforts within PC for Veterans who screen positive for unhealthy alcohol use. Mentorship will provide focused training on goals relevant for both the current CDA-2 research project and for Dr. Bachrach’s career as an independent scientist, including in-depth training in (1) implementation science; (2) alcohol-related care; (3) qualitative methods for intervention development; and (4) intervention design and evaluation.

背景。饮酒是美国成年人残疾和死亡的重要危险因素，其中一个是 在初级保健（PC）中看到的六位退伍军人报告了不健康的饮酒。不健康的饮酒与 包括自杀在内的医疗结果不良，大量社会成本和死亡的风险增加。基于 随机对照试验和美国预防服务工作组的大量证据，VA/DOD 临床准则规定，所有对不健康饮酒呈阳性的退伍军人均应接受 PC中基于证据的酒精护理，包括简短的咨询干预措施（BI）和其他治疗（例如， 药物治疗）针对患有饮酒障碍的人（AUD）。 VA是实施酒精的先驱 在PC中进行筛选和BI，但仍然存在大量实施差距。大约25％的退伍军人 不健康的饮酒仍然没有收到BIS，证据表明缺乏BIS的质量。对于那些 使用AUD，BI实施似乎并未增加对推荐服务的访问（例如推荐）或 药物治疗的障碍减少。为了提高酒精相关护理的质量和保真度， 当前的研究建议使用基于证据的实施策略，实践设施，一个VA 试点测试实践设施是否有可能提高基于PC的酒精相关护理的质量。 意义/影响。这项研究直接解决了我们这个时代最大的公共卫生危机之一 酒精比阿片类药物杀死更多的人，并且与自杀的风险增加有关。那，这项工作可能有 对退伍军人经历的不良后果的深远影响，并与顶级HSRD和VA保持一致 优先事项，包括增加获得护理和预防自杀的机会。创新。该项目将使用创新 实施技术以前不用于改善与VA酒精相关的护理。具体目标。目标1是 定性研究评估退伍军人和PC利益相关者，以了解高质量的障碍和促进者 酒精护理和使用结果以完善和尊重实践设施的干预。 AIM 2将提供实践 在小型PC样本中进行促进干预以检查其可接受性和可行性。 AIM 3是一个试点测试 在整个PC诊所中的实践设施干预，以了解实践设施是否提高质量 基于PC的酒精相关护理。方法论。 AIM 1将用不健康的酒精招募和采访退伍军人 使用（n = 20-25）和PC利益相关者（n = 10-15）来帮助完善实践设施。 AIM 2将提供 一小部分PC提供者和员工（n = 5-7）的练习设施以评估可接受性/可行性。在 AIM 3，将邀请整个诊所的PC提供者/员工参加练习机构 评估实施（例如，覆盖范围）和有效性（减少饮酒）。实施/下一个 步骤。调查结果将提交地方和国家运营伙伴，并用于改善基于证据的 全国范围内VA PC的酒精相关护理。候选人。 Rachel Bachrach博士是临床心理学家， 基于成瘾治疗的跨专业高级奖学金的博士后研究员 卫生公平研究与促进中心（CHERP），VA HSR＆D卓越研究中心。 该CDA-2的目的是促进巴赫拉赫博士的过渡到独立的HSR＆D调查员 改善对加性疾病的循证护理的长期目标。短期目标是 获得正式的培训，专家精神和研究经验，以促进VA HSR＆D职业的重点 改善PC内预防和干预工作的退伍军人，这些退伍军人筛选不健康酒精的阳性 使用。指导将为目前的CDA-2研究项目和 对于Bachrach博士作为独立科学家的职业，包括（1）实施科学的深入培训； （2）与酒精有关的护理； （3）开发干预的定性方法； （4）干预设计和 评估。