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.

项目概要/摘要 背景：初级保健 (PC) 中危险饮酒筛查呈阳性的退伍军人相对较少 筛查酒精后一年内的酒精护理 这表明现有的 VHA 连接选项。 需要酒精护理的退伍军人，包括患有危险饮酒和创伤后应激障碍 (PTSD) 的共病者和/或 为此，我们已经确定并建议对一种有希望的方法进行试点测试。 基于证据的干预措施，基于优势的酒精护理联系（SLAC）有潜力。 加强退伍军人与酒精护理的联系，并改善饮酒和心理健康结果 与 PC 中的 A-MH 一起。 意义：现有的 VHA 选项（例如 VHA 推荐的简短酒精咨询）并没有改善 与酒精护理的联系，表明迫切需要采取更深入但实际的努力，将退伍军人与酒精护理联系起来 A-MH 到护理 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) 将患有 A-MH 的退伍军人与 VA 和非 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：拟议的项目具有高度创新性，因为它为关键问题提供了解决方案 VHA 护理方面的差距，其中大多数需要酒精护理的退伍军人没有接受这种护理，这测试了一种增加策略。 与酒精护理的联系，既足够密集以产生改变，又可以在繁忙的临床中使用 SLAC 的一个高度创新的特点是，对教职人员的要求太高。 PC 提供商如何将患有 A-MH 的退伍军人与酒精护理联系起来，这可能有助于使有关酒精护理的对话正常化 作为 PC 提供者缺乏知识的一部分，患者的饮酒情况及其在 PC 中的护理选择。 关于如何治疗危险饮酒是退伍军人接受酒精护理的一个重大障碍。 SLAC 的独特和创新特点是它利用患者自我认定的优势、能力和技能来 帮助他们联系酒精护理选项。 具体目标：我们的两个目标是（目标 1）：使 SLAC 适应 A-MH 退伍军人的使用和交付 我们将通过电话在 VHA PC 环境中对退伍军人、PC 工作人员和我们的人员进行定性访谈。 VACO 运营合作伙伴确保 SLAC 的内容和格式经过调整，使其具有相关性 并为这些利益相关者所接受（目标 2）：确定 (a) 进行更大规模的可行性。 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 与 A-MH 在 PC 中的应用，并探索 (c) SLAC 在退伍军人群体中的功效 为了实现目标 2，我们将。 在两个 VA 医疗机构（阿肯色州小石城和加利福尼亚州帕洛阿尔托）进行 SLAC 多站点试点 RCT。 实现目标 2a-b，我们将衡量可行性（例如，注册率和随访率、对 SLAC 的忠诚度） 干预）进行后续更大的 RCT（以测试 SLAC 的有效性）和 SLAC 的可接受性 （SLAC 完成率、对 SLAC 的满意度） 退伍军人为了实现目标 2c，我们将探索 SLAC 在改善退伍军人与酒精护理的联系和利用以及他们的酒精和精神方面的功效 3 个月随访时的健康结果。 方法：我们将使用（目标 1）定性访谈来调整 SLAC，使其适用于具有 A-MH 的退伍军人和 PC， （目标 2）在试点随机对照试验之后将进行多地点试点随机对照试验的情况汇报访谈。 后续步骤/实施：如果我们的发现证明后续项目的合理性，我们计划提出一个完整的方案 采用混合设计的动力多中心研究，测试 SLAC 在 VHA 中交付时的临床有效性 PC 同时观察和收集有关 SLAC 在此环境中的实施潜力的信息。 如果发现 SLAC 有效，运营合作伙伴将致力于在全国范围内实施 SLAC。