A randomized clinical trial of SBIRT services in school-based health centers

学校健康中心 SBIRT 服务的随机临床试验

基本信息

批准号：
9262891
负责人：
Jan Gryczynski
金额：
$ 57.28万
依托单位：
FRIENDS RESEARCH INSTITUTE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-05-15 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9262891
关键词：
Academy Acute Address Adolescent Adolescent Medicine Adolescent sexual risk Adoption Adult Affordable Care Act Age Alcohol consumption Alcohol or Other Drugs use Alcoholic Intoxication American Baltimore Childhood Chronic Disease Cities Clinic Clinical effectiveness Computers Contraceptive methods Cost Effectiveness Analysis Data Data Reporting Drug usage Economics Eligibility Determination Enrollment Evaluation Evidence based treatment Female Adolescents Frequencies Funding HIV HIV Infections HIV risk Health Health Benefit Health Services Healthcare Illicit Drugs Immunization Individual Intervention Life Longevity Male Adolescents Marijuana Maryland Medical Modeling Motivation National Institute of Drug Abuse Nurse Practitioners Outcome Participant Pathway interactions Patient Self-Report Patients Pattern Pediatrics Primary Health Care Process Provider Public Health Publishing Quality-Adjusted Life Years Randomized Randomized Clinical Trials Randomized Controlled Trials Reporting Research Research Design Risk Risk Behaviors Risk Factors Risk Reduction Sample Size Schools Services Sex Behavior Sexually Transmitted Diseases Substance abuse problem Tablets Time United States Unsafe Sex Visit Youth adolescent patient adolescent substance use alcohol risk arm base behavioral outcome binge drinking brief intervention comparative comparative effectiveness computer program computerized cost cost effective cost effectiveness early onset substance use experience follow-up health care delivery health care model high school incremental cost-effectiveness innovation instrument marijuana use member motivational enhancement therapy novel patient oriented public health relevance randomized trial reduce marijuana use reduced alcohol use routine practice scale up school health screening screening, brief intervention, referral, and treatment sex sex risk social substance abuse treatment substance misuse substance using adolescents twelfth grade

项目摘要

DESCRIPTION (provided by applicant): Substance use among adolescents continues to be highly prevalent in the US. Likewise, many adolescents engage in sexual behaviors that place them at elevated risk for HIV and other sexually transmitted infections. Screening, brief intervention, and referral to treatment (SBIRT) is a promising approach for integrating substance use services into healthcare settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare delivery offering health services far beyond those of the traditional school health office. Implementing SBIRT in SBHCs could have major public health benefits, but research is needed to identify the most effective way to deliver SBIRT for adolescents in these settings. Two approaches for SBIRT that are particularly promising in their practicality, scalability, and sustainability are nurse practitioner-delivered brief intervention ad computer-delivered brief intervention. We propose to conduct a randomized controlled trial to determine the comparative clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded within two public high schools in Baltimore, Maryland. SBHC patients ages 14-18, inclusive, will be screened for eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument recommended by the American Academy of Pediatrics. The study will enroll 300 male and female adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief motivational advice as part of their medical visit, ora promising interactive computer-delivered brief intervention (CBI) based on motivational interviewing. Both intervention conditions will include HIV risk reduction content tailored based on individual risk factors, and both conditions will include a referral pathway for additional substance abuse assessment and possible treatment by specialized substance abuse treatment staff. Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will gather self-reported data on substance use and sexual risk behaviors. A focused economic analysis will compare the NBI and CBI conditions with respect to their incremental cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life years (QALYs). A qualitative process evaluation will examine adolescent participants' and SBHC staff members' perspectives on the competing BI strategies. This study has the potential for significant public health impact because it could identify the most effective SBIRT model for addressing adolescent substance use and HIV risk behaviors, both of which can have major health repercussions in the near-term and over the lifespan. The study is highly innovative in its focus on SBHCs, a rapidly expanding healthcare model that is uniquely suited to maximize the impact and reach of SBIRT for adolescents. It will be the largest randomized trial of SBIRT in US high schools, the first study of SBIRT in SBHCs, and the first study of SBIRT for adolescents in any setting to include an economic analysis.

描述（由申请人提供）：在美国，青少年的物质使用仍然很普遍。同样，许多青少年从事性行为，使他们处于艾滋病毒和其他性传播感染的风险升高。筛查，简短的干预和转介治疗（SBIRT）是将药物使用服务整合到医疗机构中的有前途的方法。以学校为基础的医疗中心（SBHC）是一种快速扩大的医疗保健模型，提供远远超出传统学校卫生办公室的保健服务。在SBHC中实施SBIRT可能会带来重大的公共卫生益处，但是需要研究以确定在这些环境中为青少年提供SBIRT的最有效方法。 SBIRT的两种方法在实用性，可伸缩性和可持续性方面特别有前途是护士从业者提供的简短干预措施广告计算机提供的简短干预。我们建议进行一项随机对照试验，以确定这两种方法在减少大麻使用，饮酒和性风险行为方面的比较临床有效性和成本效益。该研究将在马里兰州巴尔的摩的两所公立高中嵌入的SBHC进行。包括Crafft的研究人员将筛选14-18岁的SBHC患者，以获取资格美国儿科学会推荐的简短滥用筛查工具。该研究将招募300名男性和女性青少年，他们报告有风险的大麻或酒精。参与者将被随机分配，以作为他们的医疗访问的一部分，由简短的动机建议（NBI）接受护士从业者进行简短干预（NBI），OR有望基于动机访谈的互动式计算机交付的简短干预（CBI）。两种干预条件都将包括根据个人风险因素量身定制的艾滋病毒风险含量，两种情况都将包括用于额外药物滥用评估的转介途径以及专用药物滥用治疗人员可能的治疗。研究评估将在基线和3个月的随访中进行，并将收集有关使用物质使用和性风险行为的自我报告的数据。重点的经济分析将与NBI和CBI条件相比，其针对选定的主要行为结果和质量调整后的终身年份（QALYS）的逐步成本效益。定性的过程评估将研究青少年参与者和SBHC工作人员对竞争性BI策略的观点。这项研究可能会产生重大的公共卫生影响，因为它可以确定最有效的SBIRT模型，以解决青少年物质使用和HIV风险行为，这两种模型都可能在近期和寿命上产生重大的健康影响。这项研究的重点是SBHCS，这是一种迅速扩展的医疗保健模型，非常适合最大程度地提高SBIRT对青少年的影响和影响力。它将是美国高中最大的SBIRT随机试验，SBHC中的首次研究，也是对青少年的首次研究，以包括经济分析。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers.

DOI：
10.1016/j.drugalcdep.2020.108423
发表时间：
2021-01-01
期刊：
DRUG AND ALCOHOL DEPENDENCE
影响因子：
4.2
作者：
Gryczynski, Jan;Mitchell, Shannon Gwin;Schwartz, Robert P.;Dusek, Kristi;O'Grady, Kevin E.;Cowell, Alexander J.;Barbosa, Carolina;Barnosky, Alan;DiClemente, Carlo C.
通讯作者：
DiClemente, Carlo C.