Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery

优化急诊室的酒精简短干预措施：计算机与临床医生交付

• 批准号: 8692612
• 负责人: Frederic C Blow
• 金额: $ 64.53万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-20 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8692612
• 关键词: AIDS prevention; Accident and Emergency department; Address; Adoption; African American; Age; Alcohol abuse; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Back; Caring; Clinical; Code; Communities; Computers; DSM-IV; Data; Dependence; Detection; Development; Diagnosis; Effectiveness; Elements; Emergency Department patient; Emergency Department-based Intervention; Enrollment; Ensure; Equilibrium; Ethnic Origin; Exercise; Feedback; Frequencies; Gender; Goals; HIV risk; Habits; Health; Health Personnel; Healthcare; Individual; Injury; Inpatients; Intervention; Intervention Studies; Intervention Trial; Location; Mediation; Mediator of activation protein; Medical; Medicare/Medicaid; Meta-Analysis; Methods; Modality; Modeling; Monitor; Motivation; Negative Finding; Outcome; Participant; Patients; Pattern; Primary Health Care; Psyche structure; Public Health; Race; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Regulation; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sampling Studies; Self Efficacy; Services; Severities; Site; Structure; Subgroup; System; Tablet Computer; Technology; Testing; Time; Training; Translating; Trauma; United States; Visit; Writing; alcohol abuse therapy; alcohol consequences; alcohol misuse; alcohol related consequences; alcohol related problem; alcohol screening and brief intervention; alcohol use disorder; base; brief alcohol intervention; brief intervention; brief motivational intervention; care systems; clinical practice; comparative efficacy; computer generated; computerized; design; drinking; evidence base; experience; improved; inner city; innovation; intervention effect; laptop; longitudinal design; low socioeconomic status; meetings; motivational enhancement therapy; physical conditioning; prevent; programs; reduced alcohol use; research study; screening; screening, brief intervention, referral, and treatment; sex; skills; substance abuse treatment; technological innovation; therapy design; touchscreen; trauma centers; treatment as usual; trial comparing; underage drinker

DESCRIPTION (provided by applicant): Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or problem alcohol use, few are screened and receive services such as brief interventions (BI) designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious and effective in a variety of health care settings. However, the evidence for their use in the ED has been mixed. There is a pressing need to develop efficacious strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing clinician-delivered BI strategies need to be modified so that they can be standardized and administered with high fidelity and minimal demands on ED staff time and resources. Computer-delivered BIs are one method to address the challenges inherent in delivering interventions in this and other healthcare settings. The proposed study will use computerized screening via touch-screen computer tablets with audio to recruit 750 inner-city ED patients screening positive for at-risk or problem alcohol use. Participants age 18-60 will be randomized to one of three conditions: 1) Computer-delivered brief intervention (C-BI; n=250); 2) Therapist-delivered brief intervention (T-BI; n=250); or 3) Enhanced usual care (EUC; n=250). All participants will receive written information regarding community resources; individuals who meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals. Stratified random assignment [by gender; meeting criteria for an alcohol use disorder - yes/no] will take place at baseline for all conditions. The aims of the study are to develop and refine tailored motivational brief interventions that are parallel in structure but have varied delivery modalities (computer vs. therapist) for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled trial comparing the efficacy of these BI approaches (C-BI, T-BI, control) on subsequent alcohol consumption and alcohol consequences, including alcohol-related injury, mental and physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit. The rigorous examination of the efficacy of therapist- vs. computer- delivered BIs, including potential moderators and mediators, will address the key limitations raised by previous trials and will determine the optimal modality for wide implementation of brief alcohol interventions in this venue. Because the ED is such an important portal for entry into the medical care system, particularly for inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational interviewing components and minimize staff resources could have a major public health impact..

描述（由申请人提供）：虽然在急诊科 (ED) 就诊的患者中，很大一部分有饮酒风险或有问题，但很少有人接受筛查并接受旨在帮助他们减少饮酒或酗酒的简短干预 (BI) 等服务。停止饮酒。 ED 不会定期提供 BI，这可能是由于可行性方面的挑战，例如员工培训、监控保真度以及维护系统以确保长期实施。酒精 BI 已被发现在各种医疗保健环境中均有效且有效。然而，它们在急诊室中使用的证据好坏参半。在这种快节奏和广泛使用的环境中，迫切需要制定有效的策略来筛选和最佳地提供酒精 BI。现有的临床医生提供的 BI 策略需要进行修改，以便能够标准化并以高保真度进行管理，并且对 ED 工作人员的时间和资源的要求最低。计算机提供的 BI 是解决在此和其他医疗保健环境中提供干预措施所固有挑战的一种方法。拟议的研究将通过带音频的触摸屏电脑平板电脑进行计算机筛查，招募 750 名内城区 ED 患者，筛查出有饮酒风险或有问题的患者。 18-60 岁的参与者将被随机分配到以下三种条件之一：1) 计算机提供的简短干预（C-BI；n=250）； 2) 治疗师进行简短干预（T-BI；n=250）；或 3) 加强常规护理（EUC；n=250）。所有参与者将收到有关社区资源的书面信息；符合酒精滥用/依赖标准的个人也将收到酒精治疗转介。分层随机分配[按性别；满足酒精使用障碍的标准 - 是/否]将在所有情况的基线上发生。该研究的目的是为有饮酒风险或有问题的患者开发和完善定制的激励性简短干预措施，这些干预措施在结构上是平行的，但具有不同的交付方式（计算机与治疗师），并进行一项随机对照试验，比较这些 BI 方法（C-BI、T-BI、对照）对后续饮酒和酒精后果的功效，包括酒精相关损伤、精神和身体健康功能以及 3 岁、6 岁和 12 岁时的 HIV 风险行为-ED 后几个月 访问。对治疗师与计算机提供的 BI（包括潜在的调节器和调解器）功效的严格检查将解决先前试验提出的关键局限性，并将确定在此场所广泛实施短暂酒精干预的最佳方式。由于急诊室是进入医疗保健系统的重要门户，特别是对于内城区患者而言，提供强调关键动机访谈内容并最大限度减少人力资源的有效酒精 BI 可能会对公共卫生产生重大影响。