Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Implementation and Cluster-Randomized Trial

初级保健中药物滥用障碍的阶段性移动干预：实施和整群随机试验

基本信息

批准号：
10405075
负责人：
Kerry Evers
金额：
$ 5.89万
依托单位：
PRO-CHANGE BEHAVIOR SYSTEMS, INC.
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-15 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10405075
关键词：
Abstinence Address Adoption Age Alcohols American Caring Client satisfaction Clinic Clinical Cluster randomized trial Contracts Data Day Care Development Electronic Health Record Federally Qualified Health Center Feedback Funding Gender Goals Hair Health Home Individual Intervention Interview Location Measures Modeling National Institute of Drug Abuse Outcome Participant Patient Care Patient Recruitments Patient Self-Report Patient-Focused Outcomes Patients Personal Satisfaction Persons Pharmaceutical Preparations Phase Positioning Attribute Primary Health Care Procedures Provider Randomized Recommendation Research Review Literature Risk Services Site Small Business Innovation Research Grant Smoking Substance Use Disorder System Technology Testing Text Messaging Translating Treatment Efficacy base behavior change brief intervention care providers clinical practice comparative efficacy craving dashboard design disorder risk drug testing feasibility testing follow-up high risk implementation intervention implementation science inclusion criteria intervention effect intervention program medical specialties mobile computing pilot test primary outcome programs prototype randomized trial response screening screening and brief intervention screening, brief intervention, referral, and treatment secondary outcome substance use therapy design therapy development tool treatment as usual uptake urgent care usability

项目摘要

Nearly 22 million Americans age 12 and older (8.1%) need treatment for a substance use disorder (SUD). While only 10%-11% of individuals requiring treatment for a SUD receive it, an estimated two-thirds see a primary care or urgent care provider every 6 months. Primary care providers are in a unique position to perform Screening, Brief Intervention, and Referral to Treatment (SBIRT). With Phase I contract funding, Pro-Change developed and piloted-tested a mobile- delivered Substance Use Intervention (SURI) designed to reduce barriers to SBIRT in primary care by delivering universal screening and feedback on SUD risk to patients at home or in the clinic. For patients at risk, the program also delivers: 1) a brief intervention based on the Transtheoretical Model of Behavior Change (TTM) to facilitate progress through the stages of change for quitting their most problematic drug, and for seeking treatment if indicated; and 2) 30 days of stage-matched text messages and four online activities addressing key topics (e.g., managing cravings). For providers, the intervention prototype includes a Clinical Dashboard that summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide a brief in-person intervention session. The program was well- received in a small pilot test. The goals in Phase I of this Fast-Track project are to program additional SURI features and functions–including Electronic Health Record (EHR) integration–required for effective integration into clinical practice and to establish the feasibility of our approach in a clinic-wide implementation in one federally qualified health center site. If feasibility is established the intervention will be tested in a cluster-randomized trial among 1300 patients recruited by 20 FQHCs randomly assigned to treatment or usual care. Outcomes will include days of use of the patient’s most problematic drug and other measures of substance use and well-being at 9 months follow-up.

近 2200 万 12 岁及以上的美国人 (8.1%) 需要药物滥用障碍 (SUD) 治疗。需要 SUD 治疗的人中有 10%-11% 接受了治疗，估计三分之二的人接受了初级护理或紧急护理初级保健提供者每 6 个月进行一次筛查、简短干预、借助第一阶段合同资金，Pro-Change 开发并试点了移动治疗转诊 (SBIRT)。提供药物使用干预 (SURI)，旨在通过提供普遍的服务来减少初级保健中 SBIRT 的障碍在家中或诊所对患者进行 SUD 风险筛查和反馈对于有风险的患者，该计划还提供：1) 基于行为改变跨理论模型（TTM）的简短干预，以促进通过戒除最有问题的药物以及寻求治疗（如果有需要）的改变阶段；以及 2) 30 天；与舞台匹配的短信和针对关键主题的四项在线活动（例如，管理渴望）。干预原型包括一个临床仪表板，总结了患者的 SUD 风险评分和阶段更改数据，并提供阶段匹配的脚本来指导简短的现场干预会议。该快速通道项目第一阶段的目标是编写额外的 SURI 功能和有效融入临床实践所需的功能，包括电子健康记录 (EHR) 集成并确定我们的方法在一个联邦合格的健康中心的诊所范围内实施的可行性如果可行性确定，干预措施将在 1300 名患者中进行整群随机试验进行测试。由随机分配到治疗或常规护理的 20 个 FQHC 招募，结果将包括患者的使用天数。 9 个月随访时最有问题的药物和其他物质使用和健康指标。