SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

在城市联邦合格的卫生中心为青少年实施 SBIRT

• 批准号: 8677856
• 负责人: Shannon Gwin Mitchell
• 金额: $ 50.02万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677856
• 关键词: Academy; Address; Adherence; Adolescent; Adolescent Medicine; Adopted; Adoption; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; American; Amphetamines; Baltimore; Behavior; Caring; Characteristics; Cities; Client satisfaction; Clinic; Clinical Trials; Code; Data; Drug usage; Effectiveness; Evidence based intervention; Evidence based practice; Federally Qualified Health Center; General Practitioners; Health; Health Care Reform; Health Personnel; Health Policy; Healthcare; Illicit Drugs; Insurance Carriers; Intervention; Interview; Knowledge; Measures; Medical; Meta-Analysis; Modeling; Monitor; Opioid; Outcome; Patients; Pattern; Pediatrics; Penetration; Personal Satisfaction; Policy Maker; Primary Health Care; Professional counselor; Prospective Studies; Provider; Public Health; Randomized; Relative (related person); Research; Research Design; Services; Site; Specialist; Substance abuse problem; Surveys; Time; Tobacco; Tobacco use; Training; United States Substance Abuse and Mental Health Services Administration; Youth; adolescent alcohol; base; behavioral health; binge drinking; brief intervention; cost; cost effective; cost effectiveness; early onset substance use; effective intervention; evidence base; implementation research; implementation science; innovation; interest; medical specialties; misuse of prescription only drugs; novel; primary care setting; prospective; randomized trial; satisfaction; screening; screening, brief intervention, referral, and treatment; social; substance abuse treatment

DESCRIPTION (provided by applicant): Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Clinical trials and meta-analyses evidence supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse, and SBIRT is recommended by the American Academy of Pediatrics. Despite federal support of SBIRT, primary care providers have been slow to adopt this evidence-based approach. Thus, research is needed to determine effective ways to implement SBIRT for adolescents so that this approach can be brought to scale and achieve its full public health impact. Guided by Proctor's conceptual model of implementation research, the proposed study is a multi-site, cluster randomized trial to compare two principal strategies of SBIRT delivery within adolescent medicine. In the Generalist Strategy, the primary care provider delivers brief intervention (BI) fo substance misuse. In the Specialist Strategy, BIs are delivered by behavioral health counselors. The 8 study sites, primary care clinics operated by a large, urban Federally Qualified Health Center in Baltimore, will be randomly assigned to implement SBIRT for adolescents using either the Generalist or Specialist strategies. Staff at each site will be trained in the assigned implementation strategy, and quarterly booster trainings will be provided during the implementation period. Implementation outcomes, including: penetration, costs/cost- effectiveness, acceptability, timeliness, fidelity/adherence, and patient satisfaction will be assessed during the 18-month-long implementation period using a complementary combination of administrative service encounter data, provider and patient surveys, and qualitative interviews. At the end of the active implementation period, all training and technical support activities will cease for 12 months in order to measure relative sustainability. Specific Aims are: (1) to examine the relative effectiveness of the Generalist v. the Specialist implementation strategies in terms of penetration of (i) BI for those adolescents for whom it is indicated and (ii referral to specialty substance abuse treatment when indicated; (2) To determine the (iii) cost and (iv) cost-effectiveness of the two strategies; and (3) to compare the two strategies in terms of key implementation factors, including (v) acceptability; (vi) timeliness; (vii) fidelity/adherene; (viii) patient satisfaction; and (ix) sustainability. The proposed study is significant because it ill fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It is innovative because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for brief interventions. Finally, the study will include novel cost data that will provide guidance about the adoption of SBIRT in adolescent health care.

描述（由申请人提供）：酒精、烟草和其他药物的使用在美国青少年中仍然非常普遍，对他们的福祉和公共健康构成威胁。临床试验和荟萃分析证据支持筛查、简短干预和转诊治疗 (SBIRT) 对于药物滥用青少年的有效性，并且 SBIRT 受到美国儿科学会的推荐。尽管联邦政府支持 SBIRT，但初级保健提供者在采用这种基于证据的方法方面进展缓慢。因此，需要进行研究来确定针对青少年实施 SBIRT 的有效方法，以便扩大这种方法的规模并实现其全面的公共卫生影响。在 Proctor 实施研究概念模型的指导下，拟议的研究是一项多中心、整群随机试验，旨在比较青少年医学中 SBIRT 实施的两种主要策略。在通才策略中，初级保健提供者对药物滥用提供简短的干预 (BI)。在专家策略中，BI 由行为健康顾问提供。 8 个研究地点（由巴尔的摩大型城市联邦合格健康中心运营的初级保健诊所）将被随机分配，使用全科或专科策略为青少年实施 SBIRT。各站点的工作人员将接受指定实施策略的培训，并在实施期间每季度提供一次强化培训。实施成果，包括：渗透率、成本/成本效益、可接受性、及时性、忠诚度/依从性和患者满意度，将在 18 个月的实施期间使用行政服务接触数据、提供者和患者调查的互补组合进行评估，以及定性访谈。在积极实施期结束时，所有培训和技术支持活动将停止 12 个月，以衡量相对可持续性。具体目标是： (1) 审查通才与专科实施策略在以下方面的相对有效性：(i) BI 对有指示的青少年的渗透率以及（ii 在有指示时转介至专业药物滥用治疗）；(2)确定两种策略的 (iii) 成本和 (iv) 成本效益；以及 (3) 比较两种策略的关键实施因素，包括 (v) 可接受性； (vii) 忠诚度；坚持; (viii) 患者满意度；以及 (ix) 可持续性。拟议的研究意义重大，因为在医疗改革下 SBIRT 有望规模化之际，它将填补有关最佳 SBIRT 实施策略的科学知识的重大空白。它具有创新性，因为这将是青少年 SBIRT 的第一项实施研究，也是首批使用实施科学概念框架进行简短干预的前瞻性试验之一。最后，该研究将包括新的成本数据，为相关研究提供指导。 在青少年保健中采用 SBIRT。