Stand Down-Think Before You Drink: An RCT of a Mobile App for Hazardous Drinking with Peer Phone Support

停下来——喝酒前三思：针对危险饮酒的移动应用程序进行随机对照试验，并提供同行电话支持

• 批准号: 10424621
• 负责人: Daniel Michael Blonigen
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424621
• 关键词: Accountability; Adherence; Age; Alcohol abuse; Alcohol consumption; Alcohols; Caring; Complex; Coupled; Data; Drug usage; Effectiveness; Foundations; Gender; Goals; Health; Health Services Accessibility; Heavy Drinking; Human; Intervention; Interview; Mediating; Mediator of activation protein; Medical; Mental Health; Mental Health Services; Methodology; Modeling; Online Systems; Outcome; Patient Care; Patients; Pilot Projects; Population; Primary Health Care; Privatization; Provider; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Recovery; Reporting; Research; Risk; Role; Secure; Self Care; Self Efficacy; Self Management; Self-Direction; Services; Severities; Site; Specialist; Suicide prevention; Telephone; Testing; Time; Training; Travel; Veterans; Visit; Work; addiction; alcohol abuse therapy; alcohol availability; alcohol seeking behavior; associated symptom; brief intervention; care delivery; care systems; connected care; cost; design; drinking; eHealth; effectiveness testing; evidence base; experience; hazardous drinking; implementation trial; improved; informant; innovation; medical specialties; mobile application; novel; novel strategies; patient engagement; patient oriented; peer; peer support; pragmatic trial; primary outcome; psychiatric comorbidity; recruit; role model; routine screening; satisfaction; social stigma; standard of care; stem; substance use; technological innovation; telephone session; tool; treatment as usual; virtual healthcare

Background: One in four Veterans presenting to VA primary care screen positive for hazardous drinking. However, due to barriers such as Veterans’ stigma about seeking alcohol use treatment and challenges with traveling to VA, most of these Veterans do not receive any alcohol-related care. Mobile applications (apps) are an innovative means of expanding access to alcohol use treatment. The evidence for mobile apps, such as “Step Away”, to improve drinking outcomes is emerging. Nevertheless, poor patient engagement remains the Achilles’ heel of these apps. Peer Specialists (“Peers”) can facilitate Veterans’ engagement with mobile apps intended for self-management of hazardous drinking by helping to orient patients to these apps and by providing technical support and accountability. In a VA HSR&D pilot study (PPO 16-305), we created a Veteran version of the Step Away app (“Stand Down: Think Before You Drink”) and conducted an open trial in which Veterans with hazardous drinking used the app while receiving Peer phone support. The intervention (“Peer- Supported [PS]-Stand Down”) was highly acceptable to patients, and patients reported significant improvements in drinking outcomes. These data provide a strong foundation for a larger pragmatic trial to test the effectiveness of the Stand Down app and PS-Stand Down to reduce hazardous drinking among Veterans seen in primary care, relative to the current standard of care that these patients receive. Significance: By capitalizing on a high-value workforce shown to improve Veterans engagement in care (i.e., Peers), this research can expand access to alcohol care for Veterans with low staff burden and, in turn, reduce the long-term health consequences associated with untreated hazardous drinking. Our proposed research responds to HSR&D priorities of Access to Care, Mental Health, and Virtual Care, and the VA MISSION Act. Innovation and Impact: Poor patient engagement severely limits the potential effectiveness of mobile apps for self-management of alcohol use problems. Use of Peers to enhance patients’ engagement with such apps is a novel approach to overcoming this problem. Peers are ideally suited to this role by virtue of their lived experience with addiction. This approach represents a novel application of the supportive accountability model of adherence to e-health interventions. Combined with VA’s expansion of Peers on Patient Aligned Care Teams (PACT), PS-Stand Down, if shown to be effective, can transform the delivery of care for Veterans in primary care who screen positive for hazardous drinking. Specific Aims: We propose to evaluate whether the Stand Down app reduces drinking among Veteran primary care patients who engage in hazardous drinking, and for whom PS-Stand Down is more effective than the app alone. Aim 1: Test whether Stand Down (vs. Usual Care; UC) and PS-Stand Down (vs. UC and vs. app only) predicts better drinking outcomes, and test mediators of these effects. Aim 2: Test for differences in satisfaction with care across conditions, and conduct qualitative interviews with patients and PACT staff to understand potential barriers/facilitators to implementing PS-Stand Down in primary care. Aim 3: Explore baseline moderators to elucidate for whom PS-Stand Down (vs. app only) is most beneficial. Methodology: In a 3-group RCT at the Palo Alto and Syracuse VAs, 274 Veteran primary patients who screen positive for hazardous drinking, received a brief intervention following a positive screen, and are not currently in alcohol use treatment will complete a baseline interview, be randomized to either (i) UC, (ii) UC plus Stand Down, or (iii) UC plus PS-Stand Down (four phone sessions with a Peer over 8 weeks to enhance app engagement), and be re-interviewed at 8, 20, and 32 weeks. For Aim 2, the CFIR framework will guide key informant interviews with 12 patients and 12 PACT providers from each site. Next Steps/Implementation: Depending on the results, we will work with our VACO partners in the Offices of Mental Health & Suicide Prevention and Connected Care to conduct a large multisite implementation trial.

背景：在VA初级保健屏幕上呈现危险饮酒阳性的四分之一的退伍军人。 但是，由于退伍军人对寻求饮酒治疗的污名以及 前往弗吉尼亚州，这些退伍军人中的大多数没有获得任何与酒精有关的护理。移动应用程序（应用程序）是 扩大获得酒精治疗的创新手段。移动应用程序的证据，例如 “走开”，改善饮酒结果正在出现。尽管如此，病人的参与度仍然很差 这些应用程序的阿喀琉斯高跟鞋。同行专家（“同行”）可以促进退伍军人参与移动应用程序 旨在通过帮助将患者定向这些应用程序和通过 提供技术支持和问责制。在VA HSR＆D试点研究（PPO 16-305）中，我们创建了一位老兵 Step Away App的版本（“倒下：在喝酒前思考”），并进行了公开试验 有危险饮酒的退伍军人在接收同行手机支持时使用了该应用程序。干预措施（“同行 - 受支持的[ps] - 下降”）是患者高度可接受的，患者报告了明显的 饮酒结果的改善。这些数据为大型务实试验提供了坚实的基础 站立应用程序的有效性和PS-and降低以减少退伍军人中的危险饮酒 参见初级保健，相对于这些患者获得的当前护理标准。 意义：通过利用一支高价值劳动力，可以改善退伍军人参与护理（即 同行），这项研究可以扩大伯恩伯恩（Burnen）低人的退伍军人的酒精护理，进而减少 与未经治疗的危险饮酒有关的长期健康后果。我们提出的研究 对访问护理，心理健康和虚拟护理的优先事项以及VA任务法的响应。 创新和影响：差的患者参与严重限制了移动应用程序的潜在有效性 饮酒问题的自我管理。使用同龄人来增强患者与此类应用程序的参与是一个 克服这个问题的新方法。同龄人理想地适合自己的角色 成瘾的经验。这种方法代表了支持责任模型的新应用 遵守电子医疗干预措施。结合VA在患者对齐护理方面的同伴扩展结合在一起 团队（协议），PS-STADD降低（如果证明是有效的话）可以改变对退伍军人的照料 初级保健筛查危险饮酒阳性的人。 具体目的：我们建议评估站立应用程序是否减少了老兵的饮酒 从事危险饮酒的初级保健患者，而PS-STAND降低的患者比 一个单独的应用。目标1：测试是否停止（与常规护理； UC）和PS-Sand Down（vs. UC和VS。 仅应用程序）预测更好的饮酒结果和这些影响的测试介质。目标2：测试差异 在各种条件下对护理的满意，并对患者和协定人员进行定性访谈 了解潜在的障碍/促进者在初级保健中实施PSSTAINT。目标3：探索 基线主持人以阐明PS-word Down（仅与应用程序）是最有益的。 方法论：在帕洛阿尔托和锡拉丘兹VAS的3组RCT中，筛查的274名资深主要患者 危险饮酒的阳性，在正面屏幕之后进行了简短的干预，目前却不是 在饮酒治疗中将完成基线访谈，随机分配给（i）UC，（ii）UC Plus Stand 向下，或（iii）UC加PS-stand Down（四个电话会话与同行超过8周以增强应用程序 参与），并在8、20和32周重新访问。对于AIM 2，CFIR框架将指导密钥 线人对每个站点的12位患者和12名PACT提供者进行访谈。 下一步/实施：根据结果，我们将与我们的Vaco合作伙伴合作 心理健康和自杀预防和连接的护理，以进行大型多站点实施试验。