Primary care prevention of stimulant diversion by high school students with ADHD

患有多动症的高中生兴奋剂转移的初级保健预防

基本信息

批准号：
8966067
负责人：
BROOKE S.G. MOLINA
金额：
$ 60万
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：
2015
资助国家：
美国
起止时间：
2015-08-15 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8966067
关键词：
17 year old Address Adolescence Adolescent Adopted Affect Alcohol or Other Drugs use Attention deficit hyperactivity disorder Attitude Caring Central Nervous System Stimulants Child Rearing Childhood Clinical Computerized Medical Record Data Development Drug Prescriptions Emergency department visit Enrollment Goals Guidelines High School Student Intervention Legal Mediating Mediation Medical Medical center National Institute of Drug Abuse Outcome Parents Patients Pattern Perception Pharmaceutical Preparations Population Prevalence Prevention Prevention Protocols Primary Health Care Provider Public Health Randomized Reporting Research Resistance Risk Risk Factors Schedule Self Efficacy Source Students Testing Time Training United States Substance Abuse and Mental Health Services Administration Universities Work Youth base behavior change clinical practice college cost design evidence base externalizing behavior high school innovation intervention effect malleable risk misuse of prescription only drugs nonmedical use older patient pediatrician peer prevent public health relevance randomized trial response success treatment as usual trend willingness

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 high school students (McCabe & West, 2013) and prevalence rates continue to rise. Stimulant-related emergency department visits increased threefold in recent years (SAMHSA, 2013a). Students with prescriptions are the primary source of stimulant diversion (selling, sharing one's medication). However, with the exception of developmental research we recently launched, clinical strategies for management of stimulant diversion have yet to be developed and empirically evaluated 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 work with primary care providers revealed 1) concern about the problem, 2) a lack of strategies for addressing it, and 3) willingness to adopt new strategies to decrease diversion potential. This application proposes to test the implementation of brief clinical practice strategies, designed to prevent stimulant diversion that pediatricians may use with their teenage patients receiving stimulant prescriptions and their parents. In response to RFA-DA-15-010, Interventions for youth who misuse/abuse prescription stimulant medications in high school and/or college-attending youth (U01)," we will conduct a randomized trial to examine the effect on patient diversion, attitudes, and intentions, of an intervention to be delivered by pediatric providers at the time of stimulant prescribing. N=375 13-17 year old patients will be enrolled across six pediatric practices for assessment prior to, and following, provider training in stimulant diversion practices. Following baseline assessment, providers at half of the practices, randomly selected within matched pairs, will receive training in the Stimulant Diversion Prevention (SDP) protocol; the remainder will implement Treatment as Usual (TAU). Providers and parents will also participate in the assessments and electronic medical record data will be collected for participating patients. We will also characterize prescribing patterns in all participating and non participating practices in the UPMC pediatric provider network independent of study participation (543 pediatricians) for comparison to regional trends. The results of this study will provide the first empirical test of a brief provider-led intervention for stimulant diversion reduction in primary care. The goals are innovative given the complete absence of such strategies in evidence-based ADHD treatment guidelines. The project addresses an immediate public health concern and is based on developmental work (R34 DA035464) that includes stakeholders (providers) as consultants to develop feasible strategies with a high likelihood of delivery. Thus, the impact of the work is expected to be high, with the result being a pragmatic, low cost, and highly disseminable means by which prescription stimulant diversion may be decreased.

描述（由申请人提供）：精神兴奋剂药物（用于治疗注意力缺陷/多动障碍；ADHD 的药物）的非医疗使用是高中生中日益普遍的处方药滥用形式（McCabe 和 West，2013 年）），并且近年来与兴奋剂相关的急诊就诊率持续上升（SAMHSA，2013a）。兴奋剂转移的主要来源（销售、分享药物）然而，除了我们最近启动的发展研究外，尚未针对初级保健提供者（经常使用药物的专业人群）制定兴奋剂转移管理的临床策略并进行实证评估。治疗 ADHD，这是 NIDA 的目标（Volkow，2012），特别是在处方药（包括兴奋剂）的非医疗用途方面（Volkow，2010）。提供者透露 1) 对问题的担忧，2) 缺乏解决该问题的策略，以及 3) 愿意采取新策略来减少转移可能性。本申请建议测试旨在防止兴奋剂转移的简短临床实践策略的实施情况。儿科医生可以与接受兴奋剂处方的青少年患者及其父母一起使用，以回应 RFA-DA-15-010，针对在高中和/或滥用处方兴奋剂药物的青少年的干预措施。大学就读青少年 (U01)，”我们将进行一项随机试验，以检查儿科服务提供者在就读大学时提供的干预措施对患者转移、态度和意图的影响。 N = 375 名 13-17 岁患者将在六个儿科诊所进行兴奋剂转移实践培训之前和之后的评估在基线评估之后，一半诊所的提供者在配对中随机选择。，将接受兴奋剂转移预防 (SDP) 方案的培训；其余人员将实施常规治疗 (TAU)，并将参与家长的活动，并为参与的患者收集电子评估医疗记录数据。我们还将描述所有参与和非参与的处方模式独立于研究参与（543 名儿科医生）的 UPMC 儿科提供者网络的参与实践，以便与区域趋势进行比较。鉴于基于证据的多动症治疗指南中完全没有此类策略，该项目首次对由提供者主导的减少兴奋剂转移的干预措施进行了实证测试。开发工作（R34 DA035464），其中包括利益相关者（提供者）作为顾问，制定可行的战略，交付的可能性很高。因此，预计该工作的影响很大，结果是务实的、低成本的。以及可减少处方兴奋剂转移的高度传播手段。