Recovery Management Checkup for Primary Care (RMC-PC) vs. Screening Brief Intervention and Referral to Treatment (SBIRT) Experiment

初级保健恢复管理检查 (RMC-PC) 与筛查、简短干预和转诊治疗 (SBIRT) 实验

• 批准号: 9418556
• 负责人: Christy K Scott
• 金额: $ 57.93万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-27 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9418556
• 关键词: Address; Adopted; Adult; Advisory Committees; Affordable Care Act; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Appointment; Back; Beer; Behavior; Cessation of life; Child Care; Chronic; Clinic; Clinical; Conduct Clinical Trials; Consumption; Control Groups; Dependence; Drug usage; Effectiveness; Enrollment; Family; Federally Qualified Health Center; Feedback; Friends; Future; Health; Health Care Costs; Health Services Accessibility; Healthcare; Heavy Drinking; Hypertension; Individual; Insurance; Lead; Life Style; Link; Measures; Mediating; Medical; Modeling; Modification; Motivation; Outcome; Participant; Patient Care; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Play; Population; Preventive service; Primary Health Care; Randomized; Recovery; Reporting; Role; Savings; Schedule; Services; Social isolation; Societies; Substance Use Disorder; Symptoms; Techniques; Telephone; Transportation; addiction; alcohol abuse therapy; barrier to care; brief intervention; care providers; checkup examination; cost; design; disability-adjusted life years; experimental study; health care service utilization; improved; intervention program; marijuana use; motivational enhancement therapy; patient screening; physical conditioning; primary care setting; programs; public health relevance; recruit; relative effectiveness; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; social stigma; support network; treatment as usual; treatment duration; trial comparing

DESCRIPTION (provided by applicant): Screening and Brief Intervention (SBI) for risky adult alcohol use consistently identifies 5-10% of patients in need of brief intervention and 2-5% in need of more formal alcohol treatment. SBI programs are often expanded to include Referral to Treatment (aka SBIRT) to address the latter patients' needs and in primary care have increased access to treatment by 15-20% via referrals leaving 80-85% still needing treatment. Effective models of linking adults with SUD to AOD treatment are clearly needed. Recovery Management Checkups (RMC) are an effective strategy for linking individuals with SUDs to AOD treatment. In 3 trials, compared to the control group, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, contributing to fewer days of substance use and fewer SUD symptoms. RMC was recently modified for primary care settings (RMC-PC) and piloted in Federally Qualified Health Centers (FQHC). Modifications include a primary care population presenting for physical health care (as opposed to AOD treatment), a refusal conversion component, telephone vs. face-to-face linkage, and referrals back to primary care when health problems are indicated. Results indicated that RMC-PC converted 75% of those who initially refused a referral for AOD treatment at the FQHC and quadrupled the linkage rate to treatment for these individuals. In the proposed trial, we will: a) recruit 300 adults needing AOD treatment at 4 FQHCs, b) randomly assign half to SBIRT and half to SBIRT+RMC-PC, and c) conduct quarterly follow-ups for 12-months. Hypotheses include: 1) Relative to the SBIRT patients, SBIRT+ RMC-PC patients will be more likely to: a) initiate AOD treatment sooner, b) receive any AOD treatment, and c) receive more days of AOD treatment; 2) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those who get more AOD treatment will report less days of: a) alcohol use, b) heavy alcohol use, c) cannabis use, d) other drug use, and e) SUD problems; 3) days of treatment will mediate the relationship between SBIRT+RMC-PC and changes in the these AOD related behaviors; 4) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those with fewer days of AOD use will have significantly less total health care utilization costs after factoring in increases in AOD treatment; 5) Days of AOD use will mediate the relationship between SBIRT+RMC-PC and total cost of health care utilization.

描述（由申请人提供）：对危险的成人酒精使用的筛查和简短干预（SBI）始终确定需要短暂干预的患者中有5-10％的患者和需要更正式的酒精治疗的患者。 SBI计划通常会扩大到包括转诊（又名SBIRT），以满足后者的需求，而在初级保健中，通过转诊将获得治疗的机会增加了15-20％，而80-85％仍需要治疗。显然需要将具有SUD的成年人与AOD治疗联系起来的有效模型。恢复管理检查（RMC）是将SUDS患者与AOD治疗联系起来的有效策略。在3个试验中，与对照组相比，RMC参与者更有可能进行治疗，更快进入并停留更长的时间，从而减少了吸毒的天数和更少的SUD症状。 RMC最近被修改为初级保健环境（RMC-PC），并在联邦合格的保健中心（FQHC）进行了试点。修改包括提供物理保健的初级保健人群（与AOD治疗相反），拒绝转换部分，电话与面对面联系以及在指出健康问题时转介给初级保健。结果表明，RMC-PC最初拒绝在FQHC上转介的AOD治疗的人中有75％的人将连锁率提高到这些人的治疗方案。 在拟议的试验中，我们将：a）招募300名需要在4 FQHC的AOD治疗的成年人，b）随机分配一半给SBIRT，将一半分配给SBIRT+RMC-PC，C）进行12个月的季度随访。假设包括：1）相对于SBIRT患者，SBIRT+ RMC-PC患者更有可能：a）早日启动AOD治疗，b）接受任何AOD治疗，C）c）接受更多的AOD治疗； 2）相对于SBIRT患者，SBIRT+RMC-PC患者以及接受更多AOD治疗的患者的报告较少的天数：a）饮酒，b）大量饮酒，c）大麻使用，d）其他药物使用，以及E）E）SUD问题； 3）几天的治疗将介导SBIRT+RMC-PC与这些与AOD相关行为的变化之间的关系； 4）相对于SBIRT患者，SBIRT+RMC-PC患者和使用AOD使用较少天数的患者在考虑到AOD治疗增加后的总医疗保健利用成本大大减少； 5）AOD使用的天数将介导SBIRT+RMC-PC与医疗保健利用率的总成本之间的关系。