Using Implementation Science for Community-Based SBIRT Delivery to Older Adults

利用实施科学为老年人提供基于社区的 SBIRT

• 批准号: 8967014
• 负责人: Denise McCray Scott
• 金额: $ 32.46万
• 依托单位: HOWARD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8967014
• 关键词: Accidents; Activities of Daily Living; Address; Adopted; Adoption; Adult; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anxiety; Awareness; Caring; Characteristics; Communities; Community Health; Community Services; Confusion; Data; Demographic Survey; Disease; Dizziness; Drug Interactions; Elderly; Emergency Department Physician; Emotional; Epidemiology; Event; Evidence based practice; Florida; Health; Healthcare; Hospitalization; Impairment; Intervention; Literature; Memory; Mental Depression; Mental Health; Metabolism; Methods; Non-Prescription Drugs; Pharmaceutical Preparations; Pilot Projects; Prevention; Prevention strategy; Primary Health Care; Privacy; Procedures; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Research Project Grants; Research Support; Risk; Self Assessment; Services; Site; Sleep Disorders; Social Health Services; Social Work; Staging; Substance abuse problem; System; Target Populations; Testing; Time; Training; Translations; Visit; aged; alcohol misuse; base; behavioral health; brief intervention; chronic pain; clinical practice; community setting; evidence base; experience; falls; implementation science; improved; innovation; member; misuse of prescription only drugs; population based; prevent; programs; public health relevance; scale up; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; social; substance abuse treatment; tool; treatment adherence; treatment program; treatment strategy

 DESCRIPTION (provided by applicant): Older adults experience chronic pain-related conditions, sleeping disorders, and anxiety and depression that are treated with prescription drugs and over-the-counter medications, often with potentially dangerous interactions with alcohol and across medications. Importantly, levels of alcohol use that are relatively safe for most adults may be unsafe for many older adults, both because of drug interactions and because of differences in metabolism and elimination and may result in accidents and impairments in activities of daily living, leading to increased emergency department and physician visits and hospitalizations. Health care analysts project that by 2030 the number of older adults with behavioral health conditions, including substance abuse disorder, will equal or exceed the number of younger people with these disorders. With these changes occurring, aging baby boomers will require a significant shift in behavioral health and substance abuse/misuse prevention strategies and treatments in the next two decades. The Primary Care Research in Substance Abuse and Mental Health for the Elderly and the Florida BRITE studies demonstrated that brief interventions have a positive impact for older adults. However, as with many interventions, there is concern about the timely translation of SBIRT from research to community-based social and health care settings. Despite the strong research support for SBIRT, its widespread and sustained implementation has not occurred. Several distinct barriers to implementation have been identified including workflow hurdles and providers' time constraints as well as issues around reimbursement and privacy. While strategies for dissemination have been suggested, evidence-based practices for guiding health care or social service professionals as to how to implement and sustain SBIRT are non-existent. The proposed pilot study will collect Information using a mixed methods approach guided by implementation science, specifically the Quality Implementation Framework. The findings will be reviewed by a Collaborative Team composed of the researchers and members of the participating service sites. This information will form the basis for the SBIRT Implementation Protocol (SIP) that will be evaluated in a larger RCT. The SIP represents an innovation for the field to have evidence-based practices and programs adopted and implemented by community service providers with quality, and sustained over time. The study aims are to: 1) Identify organizational- and staff-based barriers and facilitators relevant for the successful implementation of SBIRT 2) Implement SBIRT in community partner organizations 3) Assess the ability to recruit and retain older adults in the SBIRT program: a) identify provider specific barriers and facilitators for program reach of the target population and b) identify characteristic of older adults related to participation and retention in the SBIRT program; and, 4) Identify provider-specific technical assistants needs for continuous delivery of SBIRT and adherence to the SBIRT procedures and its sustainability over a six month period.

 描述（由申请人提供）：老年人会经历与处方药和非处方药相关的慢性疼痛、睡眠障碍、焦虑和抑郁，通常与酒精和治疗药物之间存在潜在危险的相互作用。对于大多数成年人来说相对安全的饮酒水平对于许多老年人来说可能是不安全的，这既是因为药物相互作用，也是因为新陈代谢和消除的差异，并且可能导致事故和日常生活活动受损，从而导致急诊室的人数增加以及医生就诊和住院治疗。护理分析师预测，到 2030 年，患有行为健康问题（包括药物滥用障碍）的老年人数量将等于或超过患有这些疾病的年轻人数量。随着这些变化的发生，老龄化的婴儿潮一代将需要在行为健康方面做出重大转变。老年人药物滥用和心理健康的初级保健研究和佛罗里达州 BRITE 研究表明，简短的干预措施对老年人有积极的影响。干预措施，令人担忧SBIRT 从研究及时转化为基于社区的社会和医疗保健环境 尽管 SBIRT 得到了强有力的研究支持，但其广泛和持续的实施尚未出现，包括工作流程障碍和提供者的时间限制。尽管已经提出了传播策略，但指导医疗保健或社会服务专业人员如何实施和维持 SBIRT 的基于证据的实践并不存在。拟议的试点研究将使用以下方式收集信息。以实施为指导的混合方法科学，特别是质量实施框架，由研究人员和参与服务站点的成员组成的协作团队将审查这些结果，这些信息将构成 SBIRT 实施协议 (SIP) 的基础，并在更大范围内进行评估。 RCT。SIP 代表了该领域的一项创新，即由社区服务提供商高质量地采用和实施基于证据的实践和计划，该研究旨在： 1) 确定基于组织和员工的障碍和促进因素。与成功相关实施 SBIRT 2) 在社区合作伙伴组织中实施 SBIRT 3) 评估在 SBIRT 计划中招募和留住老年人的能力：a) 确定提供商针对计划覆盖目标人群的具体障碍和促进因素，b) 确定老年人的特征与 SBIRT 计划的参与和保留相关；以及，4) 确定供应商特定的技术助理在六个月内持续交付 SBIRT 以及遵守 SBIRT 程序及其可持续性的需求。