HOW MUCH DOES SHE REALLY DRINK? AN HMO INTERVENTION

她到底喝了多少？

基本信息

批准号：
6509062
负责人：
GABRIEL J. ESCOBAR
金额：
$ 28.32万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-30 至 2004-06-30
项目状态：
已结题

项目摘要

Alcohol abuse during pregnancy is a serious problem. Research suggests that 1) abstinence is the optimum strategy, but any decrease in alcohol consumption during pregnancy is beneficial; 2) drinkers underestimate their ethanol consumption; 3) supportive counseling is better than impersonal or purely medical approaches; and 4) in the context of a supportive environment, desire for a healthy baby is a powerful motivator. We propose to test a simple intervention in a mature managed care organization. The Kaiser Permanente Medical Care Program has implemented a substance abuse harm reduction program known as Early Start in 15 obstetrics clinics in California. We propose to enhance Early Start by helping women recognize how much alcohol they consume. We will use sample vessels, photographs of similar containers, and a simple software application that permits a counselor to show a pregnant woman what the Quantity and Frequency of her ethanol consumption actually is. Our Specific Aims are to test two hypotheses. HYPOTHESIS 1: Eligible women who abuse alcohol and who are provided with intensive education and careful quantification of their ethanol consumption (Group 1, Early Start Plus, or intervention arm) will have better perinatal outcomes (e.g., lower rates of neonatal assisted ventilation) than eligible women who simply receive confidential counseling (Group 2, Early Start, or "usual care" arm). Women in these two groups will have significantly better perinatal outcomes than those who receive no counseling at all (Group 3, comparison arm). HYPOTHESIS 2: Substance abusing women in Group 1 (Early Start Plus) will have higher rates of abstinence or cutting down on their drinking than those in Group 2 (Early Start). Women in these two groups will have significantly higher rates of abstinence or cutting down on their drinking than those who receive no counseling at all (Group 3, comparison arm). These hypotheses will be tested by randomizing 15 Early Start clinics to either the intervention or usual care arms. Each arm will consist of 7-8 obstetrics clinics. In addition, 2 KPMCP clinics where Early Start is not implemented will serve as comparison sites. We anticipate retaining 600 women in each of the 3 treatment arms during a 36 month period. We will then compare rates of a combined perinatal outcome measure (which includes mortality and morbidity) as well as decreases in maternal alcohol intake in the intervention, "usual care," and comparison arms. Our long term goals are to increase patient, provider, and policymaker awareness of the importance of alcohol abuse in pregnancy and to demonstrate the applicability of a simple, targeted intervention in a managed care organization.

怀孕期间酗酒是一个严重的问题。研究表明：1）戒酒是最佳策略，但怀孕期间减少饮酒量是有益的； 2）饮酒者低估了他们的乙醇消耗量； 3）支持性咨询优于非个人或纯粹的医疗方法； 4）在支持性环境的背景下，对健康婴儿的渴望是强大的动力。我们建议在成熟的管理式医疗组织中测试简单的干预措施。 Kaiser Permanente 医疗护理计划已在加州 15 家产科诊所实施了一项名为“早期开始”的药物滥用危害减少计划。我们建议通过帮助女性认识自己的饮酒量来加强“早期开始”。我们将使用样品容器、类似容器的照片以及一个简单的软件应用程序，使咨询师可以向孕妇展示其实际乙醇消耗的数量和频率。我们的具体目标是检验两个假设。假设 1：符合条件的酗酒妇女，接受强化教育并仔细量化其乙醇消耗量（第 1 组、早期启动+或干预组）的围产期结局（例如，新生儿辅助通气率较低）仅接受保密咨询的符合资格的女性（第 2 组、早期开始或“常规护理”组）。这两组妇女的围产期结局明显好于那些完全没有接受咨询的妇女（第 3 组，比较组）。假设 2：第 1 组（早期开始+）中滥用药物的女性比第 2 组（早期开始）中的女性有更高的戒酒或减少饮酒率。与完全没有接受咨询的女性（第 3 组，比较组）相比，这两组女性的戒酒率或减少饮酒率显着更高。这些假设将通过将 15 个 Early Start 诊所随机分配到干预组或常规护理组来进行检验。每个臂将由 7-8 个产科诊所组成。此外，2家未实施早期启动的KPMCP诊所将作为比较地点。我们预计在 36 个月期间，3 个治疗组各保留 600 名女性。然后，我们将比较干预组、“常规护理”组和比较组中综合围产期结局指标（包括死亡率和发病率）的比率以及孕产妇酒精摄入量的减少情况。我们的长期目标是提高患者、医疗服务提供者和政策制定者对怀孕期间酗酒重要性的认识，并证明简单、有针对性的干预措施在管理型医疗组织中的适用性。