Impact of enhancements to smartphone-based continuing care for alcohol dependence

增强基于智能手机的酒精依赖持续护理的影响

• 批准号: 8729682
• 负责人: DAVID H GUSTAFSON
• 金额: $ 66.89万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-05 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8729682
• 关键词: Abstinence; Address; Alcohol consumption; Alcohol dependence; Alcohols; Amination; Appointment; Asthma; Attention; Biological; Cancer Patient; Caring; Child; Communication; Counseling; Disease; Economics; Effectiveness; Family; Friends; Funding; Future; Geographic Locations; HIV; Health; Heavy Drinking; Inpatients; Internet; Intervention; Left; Length; Link; Living Costs; Malignant neoplasm of lung; Measures; Mediating; Mediation; Monitor; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outpatients; Panic; Participant; Patients; Positioning Attribute; Professional counselor; Quality of life; Randomized; Readiness; Recovery; Relative (related person); Relaxation Therapy; Research; Self Efficacy; Services; Social support; Substance Use Disorder; Support System; Symptoms; System; Technology; Telephone; Testing; Time; Universities; Wisconsin; Woman; addiction; alcohol abuse therapy; alcohol use disorder; base; coping; cost; cost effective; cost effectiveness; craving; design; drinking; efficacy trial; follow-up; improved; malignant breast neoplasm; novel; policy implication; primary outcome; problem drinker; programs; quality of death; randomized trial; secondary outcome; sobriety; stressor; treatment as usual; treatment effect

DESCRIPTION (provided by applicant): Continuing care is important in the management of patients with substance use disorders. New SMART Phone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. Dr. Gustafson and colleagues at the University of Wisconsin have recently developed an addiction version of the Comprehensive Health Enhancement Support System (CHESS), a smart phone system that provides a range of functions that directly support patients. In randomized trials CHESS significantly improved: (a) quality of life and self-efficacy for women with breast cancer, (b) quality of life and costs of care in people with HIV, (c) asthma control for young children, and (d) quality of dying and survival length for lung cancer patients. Most important, findings from a recently completed NIAAA-funded study of an addiction version of CHESS (ACHESS) indicated that it produces better drinking outcomes than standard continuing care when provided to patients leaving inpatient treatment. The system's features include: Access to family, friends, and others in recovery access to discussion groups, other recovery supports, and web links tailored information on coping with stressors. Global Positioning System (GPS) alerts when patients approach risky geographic areas~ alerts/reminders of appointments~ ongoing mini assessments and check-ins (monitoring)~ and a panic button (patient or GPS activated). McKay and colleagues have also developed a telephone- based approach to continuing care, Telephone Monitoring and Counseling (TMC), which has demonstrated efficacy in two randomized trials with alcohol dependent patients. Although the ACHESS and TMC interventions use telephone technology, they have complementary strengths. ACHESS provides automated 24/7 re- co very support services and frequent assessment of symptoms and status, but does not involve regular con- tact with a counselor. TMC, on the other hand, provides regular and sustained contact with the same counselor, but does not provide ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve both automated mobile technology and counselor contact, but little is known about how best to integrate these services. To address this question, the study will feature a 2 x 2 design [ACHESS for 12 months (yes/no) x TMC for 12 months (yes/no)], in which 280 alcohol dependent patients in an intensive outpatient program (IOP) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to ACHESS produces fewer heavy drinking days than TMC or ACHESS alone, and test for TMC and ACHESS main effects. We will also conduct economic analyses, to determine the cost and cost-effectiveness of each intervention and their combination. Additional analyses will examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects. The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact.

描述（由申请人提供）：持续护理对于药物滥用障碍患者的管理非常重要。新的智能电话通信技术提供了一种在酒精治疗后提供个性化持续护理支持的新颖方式。威斯康星大学的古斯塔夫森博士及其同事最近开发了综合健康增强支持系统（CHESS）的成瘾版本，这是一种智能手机系统，可提供一系列直接支持患者的功能。在随机试验中，CHESS 显着改善： (a) 生活质量和自我效能 患有乳腺癌的女性，(b) 艾滋病毒感染者的生活质量和护理费用，(c) 幼儿的哮喘控制，以及 (d) 肺癌患者的死亡质量和生存时间。 最重要的是，最近完成的一项由 NIAAA 资助的 CHESS 成瘾版本 (ACHESS) 研究结果表明，当为离开住院治疗的患者提供比标准持续护理更好的饮酒结果时。该系统的功能包括： 与家人、朋友和恢复中的其他人联系、访问讨论组、其他恢复支持以及有关应对压力源的定制信息的网络链接。当患者接近危险地理区域时，全球定位系统 (GPS) 会发出警报 ~ 预约警报/提醒 ~ 正在进行的小型评估和登记（监控） ~ 以及紧急按钮（患者或 GPS 激活）。 McKay 及其同事还开发了一种基于电话的持续护理方法，即电话监控和咨询 (TMC)，该方法在两项针对酒精依赖患者的随机试验中证明了其有效性。尽管 ACHESS 和 TMC 干预措施使用电话技术，但它们具有互补的优势。 ACHESS 提供自动化的 24/7 康复支持服务以及对症状和状态的频繁评估，但不涉及与咨询师的定期联系。另一方面，TMC 提供与同一位顾问的定期和持续的联系，但在通话之间不提供持续的支持。酒精使用障碍的持续护理的未来可能会涉及自动移动技术和咨询师联系，但人们对如何最好地整合这些服务知之甚少。为了解决这个问题， 该研究将采用 2 x 2 设计 [ACHESS 12 个月（是/否）x TMC 12 个月（是/否）]，其中强化门诊计划 (IOP) 中的 280 名酒精依赖患者将被随机分配到一名四种情况并随访 18 个月。我们将确定在 ACHESS 中添加 TMC 是否会比单独使用 TMC 或 ACHESS 产生更少的酗酒天数，并测试 TMC 和 ACHESS 的主效应。我们还将进行经济分析，以确定每种干预措施及其组合的成本和成本效益。其他分析将检查次要结果，包括酒精使用的生物学测量，以及假设的调节和中介效应。该研究的结果将通过整合移动自动康复支持和咨询师联系来提供有关改善患者饮酒结果的重要信息。