Stimulant diversion by young adults with ADHD: piloting primary care prevention

患有多动症的年轻人的兴奋剂转移：试点初级保健预防

基本信息

批准号：
8700085
负责人：
BROOKE S.G. MOLINA
金额：
$ 26.88万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-04-01 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8700085
关键词：
Accident and Emergency department Address Affect Attention Attention deficit hyperactivity disorder Attitude Awareness Behavior Central Nervous System Stimulants Characteristics Childhood Clinical Communities Computerized Medical Record Consultations Data Development Drug Prescriptions Drug abuse Education Effectiveness Esthesia Evaluation Family Practice Feasibility Studies Focus Groups Frequencies Funding Goals Greek Guidelines Intervention Knowledge Literature NIH Program Announcements National Institute of Drug Abuse Nature Nurse Practitioners Patients Personality Pharmaceutical Preparations Physician Assistants Physicians Pilot Projects Population Preparation Prevalence Prevention Prevention strategy Primary Health Care Process Provider Public Health Reporting Risk Schedule Source Students Surveys System Testing United States Substance Abuse and Mental Health Services Administration Use Effectiveness Visit alcohol abuse prevention base college cost evidence base innovation misuse of prescription only drugs nonmedical use pediatrician prevent public health relevance satisfaction theories university student young adult

项目摘要

DESCRIPTION (provided by applicant): Nonmedical use of psychoactive stimulant medication (medication that is prescribed for the treatment of Attention-Deficit/Hyperactivity Disorder; ADHD) is an increasingly prevalent form of prescription drug misuse among young adults and in particular college students (Smith & Farah, 2011; Wilens et al., 2008). Prevalence rates of nonmedical use (use without a prescription) on college campuses are rising (e.g., DeSantis et al., 2008). Stimulant-related emergency department visits have increased threefold in recent years (SAMHSA, 2013a). College students with prescriptions are the primary source of stimulant diversion (giving away or selling one's medication). However, no clinical strategies for management of this problem have been developed for primary care providers - a professional population that frequently treats ADHD and that is being targeted by NIDA (Volkow, 2012), especially with regard to nonmedical use of prescription drugs including stimulants (Volkow, 2010). Our preliminary focus groups with primary care providers revealed either lack of awareness about stimulant diversion/misuse or lack of strategies for addressing it; all indicated concern. This R34 application proposes the initial development of brief clinical strategies that primary care providers may use to prevent diversion of stimulants by their patients with ADHD. We focus on family medicine and pediatric providers treating 18-25 year olds in post-secondary education. Within the context of the R34 Program Announcement PA-12-171, Pilot and Feasibility Studies in Preparation for Drug and Alcohol Abuse Prevention Trials, we will 1) survey providers and their physician-extenders (nurse practitioners and physician assistants) about their current practices; 2) develop and pilot test strategies for prevention of diversion to e utilized within the context of the provider:patient relationship; and 3) examine, using post- implementation survey and EMR data, provider, practice, and patient variables associated with feasibility, satisfaction, and implementation. We base our selection of variables to consider in strategy development and evaluation on Weiner's theory of innovation implementation (Weiner et al., 2009). We propose inclusion of key stakeholders (community providers) and relevant consultants in the development process to enhance innovation feasibility and implementation. The development of these strategies will be innovative due to their complete absence in the evidence-based ADHD treatment guidelines literature. The project addresses an immediate public health concern: escalating non-prescribed use of a Schedule II prescription medication (CNS stimulants) by college students. Addressing this knowledge gap has the ultimate potential, following an R01- funded well-powered study of effectiveness and moderators, to provide one pragmatic, low cost, and highly disseminable means by which prescription stimulant diversion may be decreased.

描述（由申请人提供）：非医学使用精神活性刺激药物（用于治疗注意力缺陷/多动障碍的药物； ADHD）是一种日益普遍的处方药物滥用形式，是在年轻人中，特别是大学生中的滥用药物（Smith＆Farah，2011; Wilens等，2011; Wilens等，2008）。在大学校园中，非医学使用的患病率正在上升（例如Desantis等，2008）。近年来，与刺激性相关的急诊科的访问增加了三倍（Samhsa，2013a）。有处方的大学生是刺激性转移的主要来源（赠送或出售药物）。但是，没有针对初级保健提供者制定管理此问题的临床策略 - 一种经常治疗多动症的专业人群，并且是NIDA的目标（Volkow，2012年），尤其是在非医学使用包括兴奋剂在内的处方药的非医学使用（Volkow，2010年）。我们与初级保健提供者的初步焦点小组表明，要么缺乏对刺激转移/滥用的认识，要么缺乏解决该问题的策略。所有这些都表示关注。该R34的应用提出了初步的临床策略的初步发展，初级保健提供者可能会使用该策略来防止其患者患有多动症患者的兴奋剂。我们专注于家庭医学和儿科提供者，在大专教育中接受18-25岁的孩子。在R34计划公告PA-12-171的背景下，为预防药物和酒精滥用试验做准备的飞行员和可行性研究，我们将1）调查提供者及其医师扩张者（护士从业者和医师助理）有关其当前实践； 2）制定和试点测试策略，以预防在提供者的背景下使用的转移措施：患者关系； 3）使用后实施调查和EMR数据，提供者，实践和患者变量与可行性，满意度和实施相关的患者变量进行检查。我们以韦纳的创新实施理论进行战略制定和评估中考虑的变量选择（Weiner等，2009）。我们建议将主要利益相关者（社区提供者）和相关顾问包括在开发过程中，以增强创新可行性和实施。这些策略的制定将是创新的，因为它们在循证ADHD治疗指南文献中完全缺席。该项目解决了直接的公共卫生问题：大学生对附表II处方药（CNS兴奋剂）的非处方使用升级。根据R01资助良好的有效性和主持人的研究，解决这一知识差距具有最终的潜力，以提供一种务实，低成本和高度可观的手段，而处方刺激性转移可能会降低。