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: 10491370
• 负责人: Erin E. Bonar
• 金额: $ 68.63万
• 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/10491370
• 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; Persons; 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.

项目概要/摘要 酒精使用障碍 (AUD) 很常见，会导致广泛的功能障碍、发病率 和死亡率。循证心理社会治疗，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。 先前的努力主要集中在初级保健中的筛查、简短干预和转诊治疗 (SBIRT)。 然而，由于障碍（例如治疗可及性差、耻辱感），转诊未能增加治疗的使用 专业成瘾诊所）导致转诊患者不寻求治疗。此外，患者通常 不寻求治疗（即不接受 AUD 护理的患者）的饮酒目标可能会有所不同。因此，新 护理模式，以参与并提供跨大型、分散的范围的有效治疗 迫切需要 AUD 患者群体。 远程医疗，特别是提供者和患者之间单独的同步视频会议 地点，可以通过在家中为患者提供护理并减少治疗费用来帮助提高治疗利用率 在专业护理机构接受治疗的耻辱。远程医疗对许多情况都有效，但也有 迄今为止还没有 AUD 的疗效试验。尽管有限的远程医疗基础设施一直是远程医疗的障碍 过去，COVID-19大流行已经证明它可以快速实施并广泛使用。有一个 迫切需要确定远程医疗提供的 AUD 治疗是否能有效地为传播提供信息。 因此，本研究的目的是评估远程医疗提供的 MI-CBT 治疗干预 AUD (MI-CBT TeleTx) 与增强型日常护理 (EUC) 在 AUD 治疗利用率和酒精使用方面的比较。 将招募密歇根州东南部两个大型医疗系统中的 AUD 初级保健患者 随机分配至 MI-CBT TeleTx 或 EUC。具体目标是： 目标 1：确定提供 TeleTx 干预选项 (n=150) 与 EUC（n = 150）在 AUD 初级保健患者中使用 AUD 治疗。目标 2：确定效果 TeleTx 干预与 EUC 在 3 天内的饮酒天数百分比和重度饮酒天数百分比方面的比较 6 个月和 12 个月的随访。目标 3：确定 TeleTx 干预对酒精相关疾病的影响 后果和功能（例如生活质量、心理健康）以及酒精风险的调节作用 水平降低。此外，探索性的目的是确定干预措施影响的关键中介因素。 治疗使用（通过改善治疗可及性和减少耻辱）和饮酒（通过 治疗用途）。影响：这项研究的结果将作为一种新颖且新颖的研究对公共健康产生重大影响。 可扩展的方法来解决巨大的澳元治疗缺口。此外，这项工作将是第一个大型功效试验 远程医疗 AUD 干预并测试旨在吸引非治疗寻求的新护理模式 患者并为传统专科护理机构之外的患者提供有效的 AUD 治疗。