Remote Brief Intervention and Referral to Treatment Service for Alcohol (R-BIRT)

远程短暂干预和转介酒精治疗服务 (R-BIRT)

• 批准号: 8904195
• 负责人: Edwin D Boudreaux
• 金额: $ 69.34万
• 依托单位: POLARIS HEALTH DIRECTIONS, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-25 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8904195
• 关键词: Accident and Emergency department; Acute; Adoption; Alcohol consumption; Alcohols; Back; Behavior Therapy; Blinded; Businesses; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Clinical Trials; Code; Computer Assisted; Computer software; Consultations; Counseling; Data; Dependence; Development; Economics; Education; Electronic Mail; Emergency Department patient; Emergency department visit; Environment; Evidence based program; Exhibits; Feedback; Funding; Goals; Gold; Grant; Hand; Health; Health Care Costs; Health Care Visit; Health Personnel; Healthcare; High Prevalence; Home environment; Human; Individual; Insurance; Internet; Intervention; Interview; Knowledge; Link; Marketing; Massachusetts; Medical; Methods; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Nurses; Outcome; Participant; Patients; Persons; Phase; Physicians; Practice Guidelines; Preventive; Primary Health Care; Problem Solving; Protocols documentation; Provider; Public Health; Publications; Randomized; Randomized Controlled Trials; Registries; Reporting; Research; Research Institute; Research Personnel; Risk; Secure; Self Efficacy; Services; Signs and Symptoms; Single-Blind Study; Site; Small Business Technology Transfer Research; Substance abuse problem; Summary Reports; Technology; Telefacsimile; Telephone; Testing; Time; Training; Translations; United States Substance Abuse and Mental Health Services Administration; Universities; Visit; Woman; alcohol abuse therapy; alcohol misuse; alcohol related consequences; alcohol services; alcohol use disorder; arm; base; brief alcohol intervention; brief intervention; clinical efficacy; clinical practice; comparative effectiveness; cost effective; cost effectiveness; design; drinking; effectiveness trial; evidence base; flexibility; health care service utilization; health economics; high risk; high risk drinking; human old age (65+); improved; innovation; medical schools; men; programs; public health relevance; reduced alcohol use; response; screening; screening, brief intervention, referral, and treatment; self help; social stigma; substance abuse treatment; success; telehealth; treatment program; trial design

 DESCRIPTION (provided by applicant): Significance: The USPHSTF, SAMHSA, CDC, and NIAAA have affirmed the importance of screening in medical settings for alcohol consumption that exceeds the NIAAA low risk limits, brief educational and motivational counseling for those who screen positive or have other evidence of an Alcohol Use Disorder, and, when appropriate, referral to treatment (SBIRT). However, translation to clinical practice continues to be elusive. Polaris Health Directions (Small Business) and the University of Massachusetts Medical School (Research Institute) have partnered to solve this problem by creating the Remote Brief Intervention and Referral to Treatment service for alcohol (R-BIRT), a telehealth service for delivering evidence based alcohol brief interventions and referral to treatment during a medical encounter in a cost-effective, sustainable way. Investigators: We have extensive expertise in SBIRT for alcohol (Boudreaux, Bernstein); telehealth (Boudreaux); development, testing, and marketing of behavioral intervention technologies (Boudreaux, Harralson; Grissom); comparative effectiveness trial design and analysis (Barton); and health economics (Sachs). Combined, the team has over 100 publications related to SBIRT and constituent technology domains. Innovation: This Phase II STTR will pioneer telehealth delivery of SBIRT for alcohol. It will be flexible enough for a variety of medical settings, and will develop and expand software capable of facilitating both telehealth and in-person SBIRT delivery models. It will further innovate SBIRT research and clinical practice by exploring mechanisms of action, an objective rarely incorporated into SBIRT studies. Approach: The design is a two arm, single blind (outcomes assessor), randomized, non-inferiority trial. Emergency department (ED) patients (n=356) who drink above the NIAAA low risk limits or have evidence of an Alcohol Use Disorder will be randomized to the telehealth model (R-BIRT) or a gold-standard in-person intervention (SBIRT) and followed for 6 months post-visit using a multi-method outcomes attainment plan. The study will establish the non-inferiority of the telehealth model compared to the in-person model in reducing alcohol use and alcohol related consequences, while showing that the telehealth model is the more cost effective of the two. Mechanisms of action, including patient knowledge of low risk drinking limits, motivation, self-efficacy, substance abuse treatment initiation, and self-help program engagement, will be examined. Environment: With the success of the R-BIRT Phase I and other relevant projects, including previous large scale Phase II STTR clinical trials, Polaris and UMass have clearly established their capability of successfully carrying out this study, disseminating its results, and marketing the final product. Impact: Because alcohol misuse, abuse, and dependence carries an enormous burden in both human suffering and healthcare costs, a strategy that provides high quality, evidence based care in a manner that is more cost effective and easier than existing models has potential to exert a substantial impact on public health.

 描述（由适用提供）：意义：USPHSTF，SAMHSA，CD​​C和NIAAA影响了在医疗环境中筛查的重要性，超过了NIAAA的饮酒量，而NIAAA的低风险限制，对那些筛查阳性或其他证据表现出阳性或其他证据的人，以及适当的治疗时（s to Treapral for Beartral（Sbirt））的简短教育和动机咨询。但是，转化为临床实践仍然是弹性的。 Polaris Health指示（小型企业）和马萨诸塞大学医学院（研究所）已通过创建远程简短干预措施并转介到酒精治疗服务（R Birt），这是一项远程医疗服务，这是一种提供证据基于证据的酒精短暂干预措施，并在医疗遭遇期间以成本效益，可持续的，可持续的，可持续的，可持续的方式转诊。调查人员：我们在酒精的Sbirt方面拥有广泛的专业知识（Boudreaux，Bernstein）；远程医疗（Boudreaux）；行为干预技术的开发，测试和营销（Boudreaux，Harralson； Grissom）；比较有效性试验设计和分析（Barton）；和卫生经济学（SACHS）。该团队结合在一起，有100多个与Sbirt相关的出版物，并构成了技术领域。创新：II阶段的STTR将先驱远程医疗提供酒精。对于各种医疗环境，它将足够灵活，并且将开发和扩展能够支持远程医疗和亲自交付模型的软件。它将通过探索行动机制来进一步创新SBIRT研究和临床实践，这是一个很少纳入SBIRT研究的客观。方法：设计是一个两臂，单盲（结果评估），随机，非效率试验。急诊科（ED）患者（n = 356）在NIAAA低风险限制或有饮酒障碍的证据以上的患者（n = 356）将被随机分为远程医疗模型（R Birt）或金标准的亲自干预（SBIRT），然后使用多Method Etcomes属性计划进行参与后6个月。这项研究将与降低酒精使用和与酒精相关的后果的面对面模型相比，将建立远程医疗模型的不效率，同时表明远程医疗模型是两者中更具成本效益的。将检查行动机制，包括患者了解低风险饮酒限制，动机，自我效力，药物滥用治疗计划和自助计划参与的知识。环境：随着R Birt I期和其他相关项目的成功，包括先前的大型II期STTR临床试验，Polaris和UMass显然已经确立了成功进行这项研究，传播其结果并销售最终产品的能力。影响：因为滥用酗酒，滥用和依赖性在人类苦难和医疗保健成本中都具有增强的烧伤，这种策略以比现有模型更具成本效益和更容易的方式提供了高质量的基于证据的护理，这可能会对公共卫生产生重大影响。