A randomized clinical trial of SBIRT services in school-based health centers

学校健康中心 SBIRT 服务的随机临床试验

• 批准号: 9262891
• 负责人: Jan Gryczynski
• 金额: $ 57.28万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9262891
• 关键词: Academy; Acute; Address; Adolescent; Adolescent Medicine; Adolescent sexual risk; Adoption; Adult; Affordable Care Act; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcoholic Intoxication; American; Baltimore; Childhood; Chronic Disease; Cities; Clinic; Clinical effectiveness; Computers; Contraceptive methods; Cost Effectiveness Analysis; Data; Data Reporting; Drug usage; Economics; Eligibility Determination; Enrollment; Evaluation; Evidence based treatment; Female Adolescents; Frequencies; Funding; HIV; HIV Infections; HIV risk; Health; Health Benefit; Health Services; Healthcare; Illicit Drugs; Immunization; Individual; Intervention; Life; Longevity; Male Adolescents; Marijuana; Maryland; Medical; Modeling; Motivation; National Institute of Drug Abuse; Nurse Practitioners; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Pattern; Pediatrics; Primary Health Care; Process; Provider; Public Health; Publishing; Quality-Adjusted Life Years; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Sample Size; Schools; Services; Sex Behavior; Sexually Transmitted Diseases; Substance abuse problem; Tablets; Time; United States; Unsafe Sex; Visit; Youth; adolescent patient; adolescent substance use; alcohol risk; arm; base; behavioral outcome; binge drinking; brief intervention; comparative; comparative effectiveness; computer program; computerized; cost; cost effective; cost effectiveness; early onset substance use; experience; follow-up; health care delivery; health care model; high school; incremental cost-effectiveness; innovation; instrument; marijuana use; member; motivational enhancement therapy; novel; patient oriented; public health relevance; randomized trial; reduce marijuana use; reduced alcohol use; routine practice; scale up; school health; screening; screening, brief intervention, referral, and treatment; sex; sex risk; social; substance abuse treatment; substance misuse; substance using adolescents; twelfth grade

DESCRIPTION (provided by applicant): Substance use among adolescents continues to be highly prevalent in the US. Likewise, many adolescents engage in sexual behaviors that place them at elevated risk for HIV and other sexually transmitted infections. Screening, brief intervention, and referral to treatment (SBIRT) is a promising approach for integrating substance use services into healthcare settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare delivery offering health services far beyond those of the traditional school health office. Implementing SBIRT in SBHCs could have major public health benefits, but research is needed to identify the most effective way to deliver SBIRT for adolescents in these settings. Two approaches for SBIRT that are particularly promising in their practicality, scalability, and sustainability are nurse practitioner-delivered brief intervention ad computer-delivered brief intervention. We propose to conduct a randomized controlled trial to determine the comparative clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded within two public high schools in Baltimore, Maryland. SBHC patients ages 14-18, inclusive, will be screened for eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument recommended by the American Academy of Pediatrics. The study will enroll 300 male and female adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief motivational advice as part of their medical visit, ora promising interactive computer-delivered brief intervention (CBI) based on motivational interviewing. Both intervention conditions will include HIV risk reduction content tailored based on individual risk factors, and both conditions will include a referral pathway for additional substance abuse assessment and possible treatment by specialized substance abuse treatment staff. Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will gather self-reported data on substance use and sexual risk behaviors. A focused economic analysis will compare the NBI and CBI conditions with respect to their incremental cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life years (QALYs). A qualitative process evaluation will examine adolescent participants' and SBHC staff members' perspectives on the competing BI strategies. This study has the potential for significant public health impact because it could identify the most effective SBIRT model for addressing adolescent substance use and HIV risk behaviors, both of which can have major health repercussions in the near-term and over the lifespan. The study is highly innovative in its focus on SBHCs, a rapidly expanding healthcare model that is uniquely suited to maximize the impact and reach of SBIRT for adolescents. It will be the largest randomized trial of SBIRT in US high schools, the first study of SBIRT in SBHCs, and the first study of SBIRT for adolescents in any setting to include an economic analysis.

描述（由申请人提供）：在美国青少年中药物使用仍然非常普遍。同样，许多青少年的性行为使他们感染艾滋病毒和其他性传播感染的风险较高。筛查、简短干预和转诊治疗 (SBIRT) 是将药物滥用服务纳入医疗保健环境的一种很有前途的方法。学校健康中心 (SBHC) 是一种快速扩张的医疗保健服务模式，提供的健康服务远远超出传统学校健康办公室的范围。在 SBHC 中实施 SBIRT 可能会带来重大的公共卫生益处，但需要进行研究以确定在这些环境中为青少年提供 SBIRT 的最有效方法。 SBIRT 的两种方法在实用性、可扩展性和可持续性方面特别有前景，即执业护士提供的简短干预和计算机提供的简短干预。我们建议进行一项随机对照试验，以确定这两种方法在减少大麻使用、饮酒和性危险行为方面的临床有效性和成本效益比较。该研究将在马里兰州巴尔的摩两所公立高中内的 SBHC 中进行。 14-18 岁（含）的 SBHC 患者将由 CRAFFT 的研究人员进行资格筛查， 美国儿科学会推荐的一种简短的药物滥用筛查工具。该研究将招募 300 名报告有吸食大麻或饮酒危险的男性和女性青少年。参与者将被随机分配接受执业护士提供的简短干预（NBI），其中包括作为医疗访问的一部分的简短动机建议，或基于动机访谈的有希望的交互式计算机提供的简短干预（CBI）。这两种干预条件都将包括根据个人风险因素量身定制的艾滋病毒风险降低内容，并且这两种条件都将包括额外药物滥用评估的转诊途径以及由专门的药物滥用治疗人员进行可能的治疗。研究评估将在基线以及 3 个月和 6 个月的随访中进行，并将收集有关药物使用和性危险行为的自我报告数据。重点经济分析将比较 NBI 和 CBI 条件对于选定的主要行为结果和质量调整生命年 (QALY) 的增量成本效益。定性过程评估将检查青少年参与者和 SBHC 工作人员对竞争 BI 策略的看法。这项研究具有对公共卫生产生重大影响的潜力，因为它可以确定解决青少年药物使用和艾滋病毒危险行为的最有效的 SBIRT 模型，这两种行为都可能在短期内和整个生命周期产生重大健康影响。该研究在关注 SBHC 方面具有高度创新性，SBHC 是一种快速扩展的医疗保健模式，特别适合最大限度地提高 SBIRT 对青少年的影响和覆盖范围。这将是美国高中最大的 SBIRT 随机试验、SBHC 中的第一项 SBIRT 研究，以及任何环境下针对青少年的第一项包含经济分析的 SBIRT 研究。

项目成果

Fentanyl exposure and preferences among individuals starting treatment for opioid use disorder.

开始治疗阿片类药物使用障碍的个体中芬太尼的暴露和偏好。

• 发表时间: 2019
• 影响因子: 4.2
• 作者: Gryczynski, Jan;Nichols, Helen;Schwartz, Robert P;Mitchell, Shannon Gwin;Hill, Paulette;Wireman, Kim
• 通讯作者: Wireman, Kim

Sexually Transmitted Infection Testing After Brief Intervention for Risk Behaviors in School-Based Health Centers.

在学校健康中心对危险行为进行短暂干预后进行性传播感染检测。

• 发表时间: 2022-04
• 作者: Sharma, Anjalee;Mitchell, Shannon Gwin;Nordeck, Courtney D;Schwartz, Robert P;Dusek, Kristi;O'Grady, Kevin E;Gryczynski, Jan
• 通讯作者: Gryczynski, Jan

Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups.

了解不同物质使用者群体的高成本医疗保健使用模式。

• 发表时间: 2016-01
• 作者: Gryczynski, Jan;Schwartz, Robert P;O'Grady, Kevin E;Restivo, Lauren;Mitchell, Shannon G;Jaffe, Jerome H
• 通讯作者: Jaffe, Jerome H

Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers.

计算机与执业护士对学校健康中心的青少年大麻、酒精和性危险行为进行了简短的干预。

• 发表时间: 2021-01-01
• 影响因子: 4.2
• 作者: Gryczynski, Jan;Mitchell, Shannon Gwin;Schwartz, Robert P;Dusek, Kristi;O'Grady, Kevin E;Cowell, Alexander J;Barbosa, Carolina;Barnosky, Alan;DiClemente, Carlo C
• 通讯作者: DiClemente, Carlo C