Improving alcohol and substance use care access, outcomes, and equity during the reproductive years: A Type 1 Hybrid Trial in Family Planning Clinics

改善育龄期酒精和药物滥用护理的获取、结果和公平性：计划生育诊所的 1 类混合试验

• 批准号: 10706526
• 负责人: Kelli Stidham Hall
• 金额: $ 68.22万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10706526
• 关键词: Academy; Acceleration; Address; Administrator; Adoption; Age; Alcohol consumption; Alcohols; Behavioral; COVID-19; COVID-19 pandemic; Caring; Clinic; Clinical; Community Health; Competence; Computerized Medical Record; Consolidated Framework for Implementation Research; Contraceptive Agents; Contraceptive methods; Coupled; Data; Discipline of obstetrics; Disparity; Disparity population; Drug Screening; Drug usage; Equity; Ethnic Origin; Evidence based intervention; Family Planning; Forcible intercourse; Funding; Gender; HIV; Health; Health Services Accessibility; Healthcare; Heavy Drinking; Infrastructure; Intervention; Interview; Intoxication; Life Cycle Stages; Maternal Mortality; Medicaid; Medical Electronics; Medicine; Mental Health; Methods; Minority Women; Modeling; Outcome; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Populations at Risk; Poverty; Pregnancy; Preventive; Preventive healthcare; Primary Care; Process; Process Measure; Provider; Psyche structure; Quality of life; Race; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Records; Reporting; Reproductive Health; Resources; Services; Sexual Health; Sexually Transmitted Diseases; Shapes; Site; Socioeconomic Status; Source; Substance Use Disorder; Surveys; System; Technology; Telemedicine; Testing; Training; Treatment Effectiveness; Trust; United States; United States National Institutes of Health; Urbanicity; Violence; Visit; Woman; Women' s Health; aged; alcohol measurement; alcohol risk; alcohol screening; alcohol use disorder; behavioral health; condoms; contextual factors; effectiveness measure; effectiveness outcome; effectiveness testing; effectiveness/implementation trial; ethnic minority; evidence base; experience; health care service organization; health care settings; health equity; health inequalities; health organization; hybrid type 1 trial; illicit drug use; implementation facilitation; implementation science; implementation strategy; implementation trial; improved; infant morbidity/mortality; informant; innovation; marginalization; marginalized population; maternal morbidity; multidisciplinary; novel; pandemic disease; patient oriented; physical conditioning; public health relevance; racial minority; racial minority population; reproductive; response; safety net; scale up; screening, brief intervention, referral, and treatment; sex; social disparities; social stress; sociodemographics; stakeholder perspectives; substance use; treatment as usual; underserved community; unintended pregnancy; uptake; virtual

Rates of risky alcohol and drug use and alcohol and substance use disorders (AUDs/SUDs) are highest among women during their reproductive years compared to other periods of the life course. AUDs and SUDs are associated with significant and lifelong behavioral, mental, physical, and sexual and reproductive health (SRH) consequences for women and disproportionately for racially and ethnically minoritized women and those living in poverty. There is an urgent need for innovative methods to address alcohol and substance use in preventive healthcare settings. Family planning (FP) clinics are a trusted care source and primary point of access for women and serve as a safety net for structurally marginalized groups in the U.S. FP clinics are uniquely well- suited, but entirely understudied, contexts for implementing and scaling integrated alcohol/drug use services. While screening, brief intervention, and referral to treatment (SBIRT) is a widely accepted, evidence-based intervention for alcohol use in primary care and mental health settings, little is known about the facilitators and barriers to the uptake and sustainment of SBIRT in FP clinics. Even less is understood about telemedicine, which has been rapidly rolled out for COVID-19, as a SBIRT delivery platform. Further, virtually no evidence exists on effective organizational level implementation strategies to accelerate SBIRT’s adoption in FP. We propose an explanatory, sequential, mixed methods study to evaluate SBIRT in an expansive FP clinic network of a national SRH organization – a novel and highly impactful setting with a reach of a diverse and largely socially disadvantaged population of reproductive-aged women at greatest risk for AUDs/SUDs. Our integrated study draws upon the evidence-based implementation approach, Implementation and Sustainment Facilitation (ISF), guided by the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance models. In Aim 1, to identify specific targets for implementation, sustainment, and scale-up of SBIRT, we will conduct administrative surveys with clinic stakeholders (clinic directors, providers, and staff n=153) and key informant interviews with stakeholders and patients (n=40) to investigate organizational practices and perspectives on alcohol- and substance-related services. In Aim 2, we will conduct a dual randomized Type 1 Hybrid Effectiveness-Implementation trial testing SBIRT (in-person and telemedicine) vs. usual care, within a large, high-volume Northeastern affiliate of the national organization. We will randomize 600 patients across 4 clinics, collecting patient level data on alcohol and substance use primary effectiveness outcomes, as well as secondary SRH, mental/physical health, quality of life, and wellbeing outcomes at baseline, 30 days, and 3 months. Aim 3 will explore facilitators and barriers to SBIRT adoption and the ISF implementation strategy via surveys and interviews with clinic directors, providers, and staff (n=20) and patients (n=20) electronic medical records. Results will provide new, timely evidence to inform scale-up of alcohol and substance related services in FP settings nationally.

危险的酒精和吸毒率以及酒精和药物使用障碍（AUD/SUD）最高 与生命课程的其他时期相比，妇女在生殖时期。听和泡沫是 与重大和终生的行为，心理，身体以及性和繁殖健康有关（SRH） 对妇女的后果，对大致和种族少数妇女和生活的人的影响不成比例 在贫困中。迫切需要创新的方法来解决预防性的酒精和物质使用 医疗保健设置。计划生育（FP）诊所是值得信赖的护理来源和主要访问点 妇女并作为美国FP诊所结构边缘化群体的安全网是独特的 适合但完全理解的，用于实施和扩展综合酒精/吸毒服务的背景。 在筛查，简短干预和转介治疗时（SBIRT）是一个广泛接受的，基于证据的 在初级保健和心理健康环境中使用饮酒的干预措施，对促进者和 FP诊所的吸收和维持的障碍。关于远程医疗的理解更少， 它已作为SBIRT送货平台迅速推出了Covid-19。此外，几乎没有证据 存在于有效的组织级别实施策略上，以加速SBIRT在FP中的采用。 我们提出了一项删除，顺序的混合方法研究，以评估膨胀的FP中的SBIRT 国家SRH组织的诊所网络 - 一种新颖且高度影响力的环境，覆盖潜水员 以及在很大程度上处于社会弱势群体的生殖老年妇女，对澳元/SUD的风险最大。 我们的综合研究借鉴了基于证据的实施方法，实施和 维持促进（ISF），在实施研究的合并框架和 覆盖，有效性，采用，实施和维护模型。在AIM 1中，确定特定目标 为了实施，维持和规模，我们将在诊所进行行政调查 利益相关者（诊所董事，提供者和员工n = 153）以及与利益相关者和 患者（n = 40）研究与酒精和物质有关的组织实践和观点 服务。在AIM 2中，我们将进行双重随机类型1混合有效性试验试验测试 Sbirt（面对面和远程医疗）与通常的护理 国家组织。我们将在4个诊所中随机分配600名患者，收集有关酒精的患者水平数据 和物质使用主要的有效性结果，以及次要SRH，心理/身体健康，质量 生命，基线，30天和3个月的福祉。 AIM 3将探索促进者和障碍 通过调查和对诊所董事的访谈，采用SBIRT和ISF实施策略 提供者和员工（n = 20）和患者（n = 20）电子病历。结果将提供新的，及时的 在全国范围内FP环境中的酒精和物质相关服务规模的证据。