Collaborative Care for Primary Care Patients with Alcohol Use Disorders

对患有酒精使用障碍的初级保健患者的协作护理

基本信息

批准号：
8527627
负责人：
KATHARINE ANTHONY BRADLEY
金额：
$ 73.51万
依托单位：
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-25 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8527627
关键词：
Abnormal Laboratory Test Result Adult Agreement Alcohol dependence Alcohols Back Care given by nurses Caring Case Manager Chronic Chronic Care Clinical Informatics Conduct Clinical Trials Education Effectiveness Enrollment Equation Equipment and supply inventories Evidence based intervention Evidence based practice Evidence based treatment FDA approved Frequencies Health Care Costs Health Personnel Heavy Drinking Information Systems Inpatients Intention Intervention Laboratory Markers Measures Medical Mental Depression Mental Health Methods Modeling Monitor Morbidity - disease rate National Institute on Alcohol Abuse and Alcoholism Nurse Practitioners Outcome Outcome Study Patients Pharmaceutical Preparations Primary Health Care Process Measure Provider Randomized Randomized Controlled Trials Readiness Relapse Research Research Personnel Resolution Schedule System Testing Time United States National Institutes of Health Visit Woman addiction alcohol abuse therapy alcohol related problem alcohol screening alcohol screening and brief intervention alcohol use disorder base brief intervention care delivery care systems chronic care model clinical infrastructure collaborative care cost design drinking effectiveness trial evidence base experience follow-up health care service utilization health related quality of life high risk human old age (65+)improved interest medical specialties men mortality novel strategies primary care setting public health relevance secondary outcome success treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Most patients with alcohol use disorders (AUD) never receive formal alcohol treatment, even those already engaged in primary care. Medical management of AUD in primary care settings, including repeated medically-focused brief interventions (BI), has proven effective for decreasing drinking. Monitoring abnormal laboratory tests may engage patients not initially interested in changing drinking, and medications can further improve outcomes among patients with alcohol dependence. However, implementing these evidence-based treatments will not occur by provider education alone-new systems of care delivery are required. The proposed randomized controlled trial tests a Collaborative Care intervention for delivering evidence-based care to AUD patients who do not respond to alcohol screening and BI. The VA is an optimal setting for an initial test of Collaborative Care for AUD because the VA has high rates of annual alcohol screening and clinical informatics systems required for Collaborative Care. The Primary Aims of the proposed trial are to determine whether primary care patients at high risk for current AUD who are offered Collaborative Care, compared to those randomized to usual care, (1) have fewer heavy drinking days and (2) are more likely to be abstinent or drinking below recommended limits without alcohol-related problems at 12 months follow-up. Methods. This randomized controlled trial will enroll 300 adult VA primary care patients < 65 years old (~200 men and 100 women) who are at high risk for current AUD based on their frequency of heavy drinking (> 5 drinks in a day for men and > 4 for women). Patients will be randomized to:1) being offered Collaborative Care for AUD over 12 months or 2) usual care. The Collaborative Care Intervention consists of repeated scheduled visits for BI with a nurse care manager, as well as lab monitoring or medications for AUD when appropriate. The nurse care managers will be supported by a nurse practitioner and an interdisciplinary Collaborative Care Team. Main study outcomes include: 1) the number of heavy drinking days based on the Time Line Follow Back (TLFB), and 2) the proportion of patients who are abstinent or drinking below NIAAA recommended limits without alcohol-related problems based on the TLFB and Short Inventory of Problems (SIP), at 12 months. Generalized estimating equations, adjusted for appropriate covariates, will compare groups based on intention to treat. Secondary outcomes include process measures of treatment engagement, secondary drinking measures, resolution of abnormal lab markers, and inpatient health care utilization. Impact. Broad agreement exists that new approaches for delivering care to patients with AUD are needed, including offering evidence-based care within medical settings. This study, proposed by a New NIH investigator and a team of experts in collaborative care and addictions treatment, tests a system of care delivery proven effective for other mental health conditions. The study team has extensive success designing, testing, and implementing systems for alcohol screening and BI nationwide in VA and conducting clinical trials for AUD, which will inform the proposed study.

描述（由申请人提供）：大多数酒精使用障碍 (AUD) 患者从未接受过正式的酒精治疗，即使是那些已经从事初级保健的患者也是如此。事实证明，初级保健机构中 AUD 的医疗管理，包括重复的以医疗为重点的简短干预措施 (BI)，对于减少饮酒是有效的。监测异常的实验室测试可能会吸引最初对改变饮酒不感兴趣的患者，而药物可以进一步改善酒精依赖患者的预后。然而，仅靠提供者教育并不能实现这些循证治疗的实施，需要新的护理服务系统。拟议的随机对照试验测试了一种协作护理干预措施，为对酒精筛查和 BI 无反应的 AUD 患者提供循证护理。 VA 是 AUD 协作护理初始测试的最佳环境，因为 VA 每年进行酒精筛查的比例很高，并且拥有协作护理所需的临床信息系统。拟议试验的主要目的是确定当前 AUD 高风险的初级保健患者接受协作护理时，与随机接受常规护理的患者相比，是否 (1) 酗酒的天数较少，(2) 更有可能在 12 个月的随访中戒酒或饮酒低于建议限度，且没有与酒精相关的问题。方法。这项随机对照试验将招募 300 名年龄 < 65 岁的成年 VA 初级保健患者（约 200 名男性和 100 名女性），根据他们大量饮酒的频率（男性每天饮酒超过 5 杯，并且超过 5 杯），他们处于当前 AUD 的高风险。 4 女性）。患者将被随机分配到：1) 在 12 个月内接受 AUD 协作护理或 2) 常规护理。协作护理干预包括护士护理经理对 BI 进行重复定期访视，以及适当时进行 AUD 实验室监测或药物治疗。护士护理经理将得到一名执业护士和跨学科协作护理团队的支持。主要研究结果包括：1) 基于时间线追踪 (TLFB) 的酗酒天数，以及 2) 根据 TLFB 和12 个月的短期问题清单 (SIP)。根据适当的协变量调整的广义估计方程将根据治疗意图对各组进行比较。次要结果包括治疗参与度的过程测量、二次饮酒测量、异常实验室标记物的解决以及住院患者医疗保健的利用。影响。人们普遍认为需要新的方法为 AUD 患者提供护理，包括在医疗环境中提供循证护理。这项研究由美国国立卫生研究院的一名新研究人员和协作护理和成瘾治疗专家团队提出，测试了一种已被证明对其他心理健康状况有效的护理服务系统。研究团队在 VA 全国范围内设计、测试和实施酒精筛查和 BI 系统方面取得了广泛的成功，并开展了 AUD 临床试验，这将为拟议的研究提供信息。