Web-based Intervention to Reduce Alcohol Use in Veterans with Hepatitis C

基于网络的干预措施减少丙型肝炎退伍军人的饮酒

• 批准号: 8804188
• 负责人: Keith N. Humphreys
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8804188
• 关键词: Address; Adopted; Adoption; Aftercare; Alcohol consumption; Antiviral Agents; Antiviral Therapy; Behavioral; Budgets; Caring; Clinic; Clinic Visits; Clinical; Data; Development; Diffusion; Effectiveness; Eligibility Determination; Evaluation; Experimental Designs; Feedback; Fibrosis; Habits; Health; Health Services Accessibility; Health Status; Healthcare; Healthcare Systems; Heavy Drinking; Hepatitis C; Hepatitis C virus; Hybrids; Improve Access; Inpatients; Intervention; Interview; Intranet; Knowledge; Light; Link; Medical; Medical center; Mental Health; Mental Health Services; Methods; Online Systems; Outcome; Outpatients; Participant; Patients; Perception; Pharmacy facility; Population; Primary Health Care; Protocols documentation; Provider; Public Health; Randomized; Resources; San Francisco; Self-Administered; Services; Site; Site Visit; Substance Use Disorder; System; Technology; Time; Veterans; alcohol abuse therapy; alcohol misuse; alcohol related consequences; alcohol use disorder; base; brief alcohol intervention; care seeking; cost; design; drinking; evidence base; evidence based guidelines; follow-up; forging; health administration; health care service utilization; improved; innovation; interest; meetings; motivational enhancement therapy; operation; psychological distress; reduced alcohol use; response; satisfaction; scale up; treatment as usual

DESCRIPTION (provided by applicant): As many as 80% of Veterans with the hepatitis C virus (HCV) engage in harmful drinking. This is a major health challenge given that even light and moderate alcohol consumption can worsen the course and consequences of HCV and can be a barrier to receiving antiviral therapy. In response, the VA Uniform Mental Health Services Package has made it a priority that HCV and other ambulatory clinics provide evidence-based mental health services to all Veterans engaging in harmful drinking within two week (but preferably the same day as the clinic visit). Our CREATE partners, the VA Office of Mental Health Services, VA Operations (10N), and the VA Office of Public Health, are strongly committed to achieving this standard throughout the Veterans Health Administration (VHA). However, the cost and organizational challenges to meeting this mandate in HCV clinics are enormous, but may be surmountable through the use of self-directed technology that minimizes demands on scarce staff time. The primary objective of this study is to implement and evaluate a web-based brief alcohol intervention (BAI) for treating Veterans with HCV and seeking care at two VA HCV clinics - Veterans Affairs Palo Alto Health Care System (VAPAHCS) and San Francisco Veterans Affairs Medical Center (SFVAMC). This study will have three aims: First (Aim 1), we plan to assess patient, provider, and system factors that may impact the initial adoption of this intervention in two VA HCV clinics. These data will result in the development of a protocol for the initial implementation of the web-based BAI at our two study sites. A secondary aim will involve obtaining patient and provider feedback on an existing web-based BAI (see www.bmi-aft.org, VA Intranet Only) to help inform its redesign for use with this population. Second (Aim 2), we will implement and examine the effectiveness of a web-based BAI in two HCV clinics to reduce alcohol consumption in Veterans with HCV at three- and six-months post-treatment. Third (Aim 3), we will conduct a budget impact analysis to estimate the short-term costs (1-3 years) of adoption and diffusion of the web-based BAI and the trajectory of health care spending for study participants. This mixed-methods study will utilize qualitative and quantitative methods to achieve its three primary aims. To address aim 1, qualitative interviews will be used to collect data that will inform the initial implementation and re-versioning of a web-based BAI for use in two HCV clinics located at the Palo Alto and San Francisco. To address aim 2, we will use a randomized, hybrid (type 1) design with patient level clinical outcome data and formative evaluation data collected to examine the effectiveness of the web-based BAI. "Hybrid" designs also integrate formative evaluation into experimental designs to identify factors that impact the effectiveness of implementation efforts. Formative evaluation (e.g., site visits, clinic observatio, and interviews with staff and patients) will be used to improve the adoption of the web-based BAI at both sites and to provide evidence-based guidance to our CREATE operational partners for nationwide implementation. To address aim 3, we will conduct a budget impact analysis to estimate the short-term costs (1-3 years) of adoption and diffusion of the web-based BAI and the trajectory of health care spending for study participants. We plan to collect several types of utilization data, including outpatient, inpatient, and pharmacy utilization, and calculate total dollars spent for each type of health care utilization for the 6 months before and after treatment using DSS cost data.

描述（由申请人提供）： 多达80％的退伍军人患有丙型肝炎病毒（HCV）进行有害饮酒。这是一个重大的健康挑战，因为即使轻度和适度的饮酒也会恶化HCV的过程和后果，并且可能是接受抗病毒药疗法的障碍。作为回应，VA统一的精神卫生服务计划使HCV和其他卧床诊所为所有从事有害饮酒的退伍军人提供基于证据的心理健康服务的优先事项（但最好是与诊所访问的同一天）。我们的创建合作伙伴，VA精神卫生服务办公室，VA运营（10N）和VA公共卫生办公室，强烈致力于在整个退伍军人卫生管理局（VHA）中实现这一标准。但是，在HCV诊所达到这一任务的成本和组织挑战是巨大的，但可以通过使用自我指导的技术来克服，从而最大程度地减少对稀缺员工时间的需求。 这项研究的主要目的是实施和评估基于网络的简短酒精干预（BAI），用于用HCV治疗退伍军人并在两个VA HCV诊所寻求护理 - 退伍军人事务 - 退伍军人事务帕洛阿尔托医疗保健系统（VAPAHCS）和旧金山退伍军人事务医疗中心（SFVAMC）。这项研究将有三个目标：第一（AIM 1），我们计划评估可能影响两家VA HCV诊所中这种干预措施的患者，提供者和系统因素。这些数据将导致开发一个协议，以在我们的两个研究网站上最初实施基于Web的BAI。次要目标将涉及获得现有的基于Web的BAI的患者和提供者的反馈（请参阅www.bmi-aft.org，VA Intranet），以帮助其重新设计与该人群使用。其次（AIM 2），我们将在两个HCV诊所中实施并检查基于Web的BAI的有效性，以减少在治疗后三个月和六个月的HCV退伍军人中饮酒。第三（AIM 3），我们将进行预算影响分析，以估计基于Web的BAI的采用和扩散的短期成本（1 - 3年）以及研究参与者的医疗保健支出轨迹。 这项混合方法研究将利用定性和定量方法来实现其三个主要目标。为了解决AIM 1，定性访谈将用于收集数据，这些数据将为最初的实施和重新定义基于Web的BAI用于在位于Palo Alto和San Francisco的两个HCV诊所中使用。为了解决AIM 2，我们将使用随机的混合动力（类型1）设计，其中包括患者水平的临床结果数据和收集的形成性评估数据，以检查基于Web的BAI的有效性。 “混合”设计还将形成性评估整合到实验设计中，以确定影响实施工作有效性的因素。形成性评估（例如，现场访问，诊所观察以及对员工和患者的访谈）将用于改善在这两个地点的基于Web的BAI的采用，并为我们为全国范围内实施的创建运营伙伴提供基于证据的指导。为了解决目标3，我们将进行预算影响分析，以估计基于网络的BAI的采用和扩散的短期成本（1 - 3年）以及研究参与者的医疗保健支出轨迹。我们计划收集几种类型的利用数据，包括门诊，住院和药房利用，并计算用于使用DSS成本数据前后6个月内为每种类型的医疗保健利用用于每种类型的医疗保健利用的总美元。