Leveraging technology to address unhealthy drug use in primary care settings

利用技术解决初级保健机构中不健康的药物使用问题

基本信息

批准号：
9016861
负责人：
Jennifer McNeely
金额：
$ 25.43万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9016861
关键词：
Address Adoption Affect Alcohol consumption Alcohol or Other Drugs use Back Behavior Caring Cessation of life Characteristics Chronic Clinical Clinical assessments Consumption Counseling Data Development Dose Drug usage Early Intervention Early identification Electronic Health Record Elements Enrollment Failure Feedback Focus Groups Goals Health Health Educators Healthcare Healthcare Systems Individual Intervention Interview Knowledge Mainstreaming Medical Methods Modeling Participant Patients Pharmaceutical Preparations Population Primary Health Care Provider Randomized Clinical Trials Randomized Controlled Trials Research Risk Self-Administered Services Site Specialist Substance Use Disorder Surveys Tablet Computer Technology Testing Time Visit base brief alcohol intervention brief intervention design follow-up health information technology improved information gathering innovation meetings novel strategies point of care population health prevent primary care setting screening screening, brief intervention, referral, and treatment substance abuse treatment support tools tool treatment program usability

项目摘要

DESCRIPTION (provided by applicant): The failure to identify and treat unhealthy drug use among patients seen in mainstream primary care settings represents a missed opportunity to improve population health. Screening, brief intervention, and referral to treatment (SBIRT) programs have been promoted to address this, but recent randomized clinical trials have demonstrated lack of efficacy. It is time to go 'back to the drawing board' to examine new models of care that could effectively address unhealthy drug use in primary care settings. SBIRT studies have only tested a 'specialist' model, which shifts the responsibility for screening and interventions onto a specialized health educator who is not part of the regular primary care team. An alternative model, which integrates screening and interventions into regular primary care, using the same approaches that are effective for other common chronic health conditions, may be more effective for reducing unhealthy drug use. Innovative application of health information technology can overcome barriers to implementing a primary care-integrated approach. The tablet computer-based Substance Use Screening and Intervention Tool (SUSIT) is designed to increase delivery of substance use brief interventions by primary care providers. The SUSIT is informed by the Technology Acceptance Model, and has three elements: 1) time and workflow constraints are addressed with patient self-administered screening completed before the clinical encounter, with results presented to the primary care provider at the point of care; 2) provider knowledge is enhanced with clinical decision support (CDS),which has proven effective at changing provider behavior to effectively address other health conditions; and 3) provider activation is improved with clinical reminders at every primary care visit. The screening component of the SUSIT has already been developed. The objective here is to build the clinical decision support, and then test the full SUSIT model with 10 primary care providers. A mixed methods approach will assess its acceptability and adoption among providers and patients, and gather preliminary data on its efficacy for reducing moderate-risk drug use (defined as unhealthy use that is below the threshold of a substance use disorder). A pre-post design will ascertain the dose of substance use intervention received and changes in drug use among patients enrolled in the screening only (SO) versus SUSIT intervention period (n=75 in each period). There are 3 specific aims: Aim 1 is to develop clinical decision support that assists primary care providers in carrying out a brief intervention. Aim 2 is to assess the impact of the SUSIT on dose of substance use brief intervention received by patients, and Aim 3 is to gather preliminary evidence on the efficacy of the SUSIT approach for reducing moderate-risk drug use. The innovation of the SUSIT approach is to leverage health information technology to support efficient and effective delivery of substance use screening and interventions. The significance of this research is that it develops and tests an alternative, practice-integrated model for addressing unhealthy drug use in primary care.

描述（由适用提供）：未能识别和治疗主流初级保健环境中的患者中使用不健康的药物使用，这代表了改善人口健康的错过的机会。已经促进了筛查，简短的干预和转诊对治疗计划（SBIRT）计划以解决这一问题，但最近的随机临床试验表明缺乏效率。现在是时候“回到绘图板”来检查新的护理模型，这些模型可以有效地解决初级保健环境中的不健康药物使用。 SBIRT研究仅测试了一个“专家”模型，该模型将筛查和干预的责任转移到不属于普通初级保健团队的专业健康教育者身上。一种将筛查和干预措施整合到常规初级保健中的替代模型，使用对其他常见慢性健康状况有效的方法，可能更有效地减少不健康的药物使用。健康信息技术的创新应用可以克服实施主要护理综合方法的障碍。基于平板电脑的药物使用筛查和干预工具（SUSIT）旨在增加初级保健提供者的简短干预措施的交付。 SUSIT由技术接受模型告知，并具有三个要素：1）时间和工作流程限制在临床相遇之前完成的患者自我管理筛查解决，并在护理点上呈现给初级保健提供者； 2）通过临床决策支持（CD）增强了提供者知识，该支持已被证明有效地改变了提供者行为以有效解决其他健康状况； 3）在每次初级保健访问时，通过临床提醒改善了提供者的激活。 SUSIT的筛选部分已经开发。这里的目的是建立临床决策支持，然后与10个初级保健提供者一起测试SUSIT模型。一种混合方法方法将评估其在提供者和患者中的可接受性和采用，并收集有关其减少现代风险药物使用有效性的初步数据（定义为不健康的使用，低于药物使用障碍的阈值）。验证前设计将确定接受药物使用干预措施的剂量以及仅参加筛查（SO）与SUSIT干预期的患者的药物使用变化（每个时期n = 75）。有3个具体目标：目标1是建立临床决策支持，以帮助初级保健提供者进行简短的干预。目的2是评估SUSIT对患者接受的简短干预剂量的影响，而AIM 3是收集有关SUSIT方法减少现代风险药物使用的有效性的初步证据。 SUSIT方法的创新是利用健康信息技术来支持有效的物质使用筛查和干预措施。这项研究的意义在于，它开发并测试了一种替代性，实践综合的模型，用于解决初级保健中不健康的药物使用。