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：四分之一到退伍军人管理局初级保健机构就诊的退伍军人中，有害饮酒筛查结果呈阳性。 然而，由于退伍军人对寻求酗酒治疗的耻辱以及酗酒方面的挑战等障碍， 前往 VA 时，大多数退伍军人没有接受任何与酒精相关的护理。 扩大酒精治疗使用范围的创新方法，例如移动应用程序的证据。 然而，为了改善饮酒结果而采取的“远离”措施仍然存在。 这些应用程序的致命弱点是可以促进退伍军人与移动应用程序的互动。 旨在通过帮助患者了解这些应用程序并通过 在 VA HSR&D 试点研究 (PPO 16-305) 中，我们创建了一名退伍军人。 Step Away 应用程序版本（“Stand Down：喝酒前三思”）并进行了公开试验，其中 酗酒的退伍军人在接受同伴电话支持的同时使用了该应用程序。 支持的[PS]-Stand Down”）被患者高度接受，患者报告显着 这些数据为更大规模的实用试验提供了坚实的基础。 Stand Down 应用程序和 PS-Stand Down 在减少退伍军人危险饮酒方面的有效性 相对于这些患者目前接受的护理标准，在初级保健中看到的。 意义：通过利用高价值劳动力来提高退伍军人对护理的参与度（即， 同行），这项研究可以扩大退伍军人获得酒精护理的机会，工作人员负担较轻，从而减少 我们提出的研究与未经治疗的危险饮酒相关的长期健康后果。 响应 HSR&D 的优先事项：获得护理、心理健康和虚拟护理以及 VA 使命法案。 创新和影响：患者参与度差严重限制了移动应用程序的潜在有效性 使用同伴来增强患者对此类应用程序的参与是一种自我管理饮酒问题的方法。 解决这个问题的新颖方法是同龄人凭借他们的生活而非常适合这个角色。 这种方法代表了支持性问责模型的新颖应用。 结合 VA 扩大患者协调护理同行。 团队 (PACT)、PS-Stand Down 如果被证明是有效的，可以改变对退伍军人的护理服务 危险饮酒筛查呈阳性的初级保健人员。 具体目标：我们建议评估 Stand Down 应用程序是否可以减少退伍军人的饮酒情况 从事危险饮酒的初级保健患者，对于他们来说，PS-Stand Down 比 目标 1：测试是否 Stand Down（相对于 Usual Care；UC）和 PS-Stand Down（相对于 UC 和 vs. 仅应用程序）预测更好的饮酒结果，并测试这些影响的中介因素 目标 2：测试差异。 对不同条件下的护理的满意度，并对患者和 PACT 工作人员进行定性访谈，以 目标 3：探索 基线管理员来阐明 PS-Stand Down（相对于仅应用程序）对谁最有利。 方法：在帕洛阿尔托和锡拉丘兹 VA 进行的 3 组随机对照试验中，对 274 名退伍军人初级患者进行了筛查 危险饮酒呈阳性，在筛查呈阳性后接受了短暂干预，目前尚未 酒精使用治疗中将完成基线访谈，随机分配至 (i) UC，(ii) UC 加 Stand Down，或 (iii) UC 加 PS-Stand Down（在 8 周内与同行进行四次电话会议，以增强应用程序 对于目标 2，CFIR 框架将指导关键。 对每个站点的 12 名患者和 12 名 PACT 提供者进行了知情访谈。 后续步骤/实施：根据结果，我们将与以下办事处的 VACO 合作伙伴合作： 心理健康和自杀预防以及互联护理进行大型多站点实施试验。