Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth

儿科初级保健虚拟 SBIRT：通过远程医疗增加酒精和其他药物使用筛查、简短干预和转诊治疗的机会

• 批准号: 10706560
• 负责人: Stacy Ann Sterling
• 金额: $ 67.71万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 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/10706560
• 关键词: 17 year old; Academy; Acceleration; Accident and Emergency department; Accidents; Address; Adolescent; Adolescent Psychiatry; Adult; Affect; Alcohol or Other Drugs use; Alcohols; American; Anxiety; Appointment; Behavioral; Child Psychiatry; Childhood; Clinic; Clinical Data; Diagnosis; Drug Use Disorder; Drug usage; Early Intervention; Early identification; Early treatment; Education; Electronic Health Record; Eligibility Determination; Emergency Situation; Employment; Family; Frequencies; Funding; Health Care Costs; Health Personnel; Health system; Hybrids; Injury; Inpatients; Intervention; Interview; Licensing; Marijuana; Medical; Medicine; Mental Depression; Mental Health; Mental Health Services; Modality; Morbidity - disease rate; Outcome; Patient Self-Report; Patient-Focused Outcomes; Patients; Pediatrics; Persons; Population; Population Heterogeneity; Primary Care; Process; Psychiatry; Public Health; Qualifying; Quality of Care; Randomized; Reporting; Research; Resources; Risk; Sampling; Services; Speed; Structure; Symptoms; Telemedicine; Telephone; Time; Tobacco; Training; Treatment Protocols; United States National Institutes of Health; Visit; World Health; addiction; adolescent alcohol and drug use; aged; alcohol and other drug; alcohol risk; alcohol use disorder; arm; behavioral health; brief intervention; comorbidity; comparative effectiveness; computerized; cost; cost effective; cost effectiveness; depressive symptoms; effectiveness/implementation trial; evidence base; health service use; implementation cost; implementation outcomes; implementation process; improved; improved outcome; informant; insight; medical specialties; mortality; older patient; pandemic disease; pediatrician; primary care clinic; primary care patient; psychiatric comorbidity; routine care; screening; screening, brief intervention, referral, and treatment; service utilization; suicidal; telehealth; treatment arm; vaping; virtual; virtual delivery; virtual screening

PROJECT SUMMARY/ABSTRACT Adolescent alcohol and other drug (AOD) use is a major public health concern posing significant challenges to healthcare providers, patients and families. It is associated with comorbid psychiatric and medical conditions, poor educational and employment outcomes, accidents and injuries, and avoidable health services utilization and costs (e.g., emergency and inpatient). Early AOD use initiation is associated with alcohol use disorders in adulthood. Screening, Brief Intervention and Referral to Treatment (SBIRT) delivered in pediatric primary care is an effective approach to early identification and intervention and can reduce both AOD use and consequences and co-occurring mental health symptoms, yet widespread implementation is lacking, due to a variety of barriers, including the time constraints and competing priorities faced by pediatricians and lack of trained staff. Research on efficient and cost-effective modalities of SBIRT delivery in pediatric primary care is critical to expanding the evidence base and supporting broader implementation. Accelerated by the pandemic, behavioral telemedicine approaches to addressing adolescent AOD use and mental health problems are gaining momentum and offer the potential to increase the reach and impact of SBIRT in pediatric primary care. This study’s objective is to examine whether a centralized, virtually delivered modality of SBIRT, rapidly accessible by multiple pediatric primary care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD and comorbid mental health problems among adolescents at high or severe risk of AOD use disorder . In this wholly pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation trial, set in a large, real-world health system with a highly diverse population, we will randomize 20 busy, general pediatric primary care clinics with an eligible population of approximately 22,320 12-17 year old adolescents, to one of two intervention arms: 1) clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health clinician (CV-SBIRT arm), or 2) clinics where appointment-based brief interventions are delivered by a behavioral health clinician assigned to the clinic (Traditional SBIRT arm). Licensed behavioral health clinicians in both arms will be trained in the same empirically supported SBIRT protocol, differing only in its modality of delivery. The sample will include all adolescents aged 12 through 17 years seen for a Well Visit, who are at high or severe risk of AOD use disorder defined as endorsing monthly or more frequent AOD use OR any AOD use and past-two-week depressive symptoms or suicidality. We will use administrative and clinical data collected in the electronic health record during routine care to compare SBIRT implementation (rates of brief interventions and referrals), AOD and mental health outcomes (use frequency and symptom endorsement and diagnoses), specialty Addiction Medicine and Psychiatry treatment initiation and engagement, health services use (inpatient and Emergency Department), and cost-effectiveness in the intervention arms, at 1 and 2 years post-screening.

项目摘要/摘要 青少年酒精和其他药物（AOD）的使用是一个主要的公共卫生，涉及重大挑战 到医疗保健提供者，患者和家庭。它与合并的精神病和医疗状况有关 教育和就业成果不良，事故和伤害以及可避免的健康服务利用 和成本（例如，紧急情况和住院）。早期的AOD使用启动与酒精使用障碍有关 成年。在小儿初级保健中提供的筛查，简短的干预和转诊（SBIRT） 是一种有效的早期识别和干预的方法，可以减少AOD的使用和后果 以及同时发生的心理健康症状，但由于各种障碍，缺乏广泛的实施 包括儿科医生面临的时间限制和竞争优先事项以及缺乏训练的员工。研究 关于小儿初级保健中SBIRT分娩的有效和成本效益的方式，对于扩展而言至关重要 证据基础并支持更广泛的实施。由大流行，行为远程医疗加速 解决青少年AOD的使用和心理健康问题的方法正在增强，并提供 增加SBIRT在小儿初级保健中的影响力和影响的潜力。该研究的目标是检查 无论是小儿小儿主要可以迅速访问的集中式，几乎交付的Sbirt模式 可以对护理诊所进行成本有效的实施，以改善AOD和AOD的早期识别和治疗 在高或严重的AOD使用障碍风险中，青少年的合并性心理健康问题。在这个完全 务实的1型混合比较有效性实施试验，以大型现实世界的健康设置 人口高度多样的系统，我们将随机将20个繁忙的一般儿科初级保健诊所与 两个干预臂之一的合格人口约为22,320 12-17岁的青少年：1） 诊所中集中的行为健康实际上通过视频或电话提供了简短的干预措施 临床（CV-SBIRT ARM）或2）诊所，基于任命的简短干预措施由 行为健康临床分配给诊所（传统SBIRT ARM）。许可的行为健康 双臂的临床医生将接受相同的经验支持的SBIRT方案的培训，仅在其方面有所不同 交付方式。样本将包括所有见到良好访问的12至17岁的青少年，谁 处于使用AOD使用障碍的高风险或严重的风险定义为每月或更频繁地使用AOD或任何人 AOD使用和过去两周的抑郁症状或自杀。我们将使用行政和临床数据 在常规护理期间的电子健康记录中收集以比较SBIRT实施（简短率 干预和推荐），AOD和心理健康结果（使用频率和症状认可以及 诊断），特种成瘾医学和精神病学治疗计划和参与，卫生服务 使用（住院和急诊室）和干预组的成本效益，在1和2年 屏幕后。