Enhancing EP-Performed Alcohol Interventions in the ED

加强急诊科对急诊室进行的酒精干预

基本信息

批准号：
7344874
负责人：
Gail D'Onofrio
金额：
$ 66.66万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-03-10 至 2010-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7344874
关键词：
Accident and Emergency department Acute Age Alcohol consumption Alcohols Caring Characteristics Condition Cost Measures Cost-Benefit Analysis Drug abuse Economics Education Effectiveness Effectiveness of Interventions Emergency Situation Enrollment Gender Health Health Care Visit Healthcare Systems High Prevalence Hospitalization Household Human Resources Injury Intervention Interview Learning Life Measures Mediation Medical Motivation Numbers Nurses Outcome Outcome Measure Patient Self-Report Patients Pattern Physicians Population Population Heterogeneity Primary Health Care Provider Purpose Randomized Randomized Controlled Clinical Trials Rate Recommendation Relative (related person)Reporting Research Research Personnel Risk Schools Score Screening procedure Services Specialist Standards of Weights and Measures Subgroup Surveys Telephone Testing Time Training Translating Translations Variant Vehicle crash Visit Voice Work alcohol abuse therapy alcohol intervention base binge drinking day drinking early /brief intervention /therapy follow-up health care service utilization impaired driving performance injured motivational intervention programs racial and ethnic response young adult

项目摘要

DESCRIPTION (provided by applicant): A critical need exists to refine and test brief interventions (BI) for Emergency Department(ED) populations with hazardous and harmful (HH) drinking that can be translated into real-world settings; and to enhance the effects of these BIs so they can be maintained over time. The ED is an ideal setting for BIs, as many ED patients who exceed low-risk recommendations do not have contact with either alcohol treatment specialists or visit primary care medical practitioners. This includes a large segment of young adults ages 18-30 whose only contact with the health care system is often an ED visit. The purpose of this study is to evaluate the effectiveness of an enhanced Emergency Practitioner (EP) performed BI, namely, the Enhanced Brief Negotiation Interview (E-BNI). This includes a basic BNI performed in the ED with referral to a primary care provider, followed by a telephone booster intervention performed by trained nurses 1-month post ED visit. The E-BNI will be compared to the basic BNI (without booster), and standard care with assessments (SC-A) and without (SC-NA). In a randomized, controlled clinical trial 990 HH drinkers will be randomly assigned to one of the 4 conditions. Primary hypotheses to be tested include: The E-BNI will be superior to the BNI and SC conditions, and BNI will be superior to the SC conditions in (1) reducing self-reported 7-day alcohol consumption and binge drinking episodes in the past 28 days; and 2) increasing utilization of primary care and alcohol related services. Secondary hypotheses include: The E-BNI will be superior to the BNI and SC conditions, and the BNI will be superior to the SC conditions in reducing alcohol-related negative consequences and; 2) decreasing repeat ED visits and days of hospitalization; and 3) patients receiving SCA condition will report greater reductions in alcohol consumption than those receiving the SC-NA condition. We will conduct cost benefit analysis of the interventions. Follow-up assessments, at 6 and 12-months, will be obtained via interactive voice response (IVR). Unique features of the current project as compared to earlier studies include: 1) use of existing, trained EP/study staff; 2 ) a credible control condition with/without assessments to test their impact on outcomes; 3) enrollment of a heterogeneous ED population and 4) use of IVR to promote accurate, non biased subject self-reporting; and 5) an analysis of relative economic costs and benefits of the tested interventions.

描述（由申请人提供）：迫切需要改进和测试针对急诊科（ED）危险和有害（HH）饮酒人群的简短干预措施（BI），并将其转化为现实环境；并增强这些商业智能的效果，以便它们可以长期维持。急诊室是 BI 的理想场所，因为许多超出低风险建议的急诊室患者既没有接触酒精治疗专家，也没有去看初级保健医生。这包括一大部分 18-30 岁的年轻人，他们与医疗保健系统的唯一接触通常是急诊就诊。本研究的目的是评估增强型急诊从业者 (EP) 执行的 BI，即增强型简短谈判访谈 (E-BNI) 的有效性。这包括在急诊室进行基本 BNI 并转介给初级保健提供者，然后在急诊室就诊后 1 个月由经过培训的护士进行电话加强干预。 E-BNI 将与基本 BNI（无加强）以及带评估 (SC-A) 和不带评估 (SC-NA) 的标准护理进行比较。在一项随机对照临床试验中，990 名 HH 饮酒者将被随机分配到 4 种情况之一。要检验的主要假设包括： E-BNI 将优于 BNI 和 SC 条件，并且 BNI 在以下方面优于 SC 条件：(1) 减少自我报告的 7 天饮酒量和过去的酗酒事件28天； 2) 提高初级保健和酒精相关服务的利用率。次要假设包括： E-BNI 将优于 BNI 和 SC 条件，并且 BNI 在减少与酒精相关的负面后果方面将优于 SC 条件； 2) 减少急诊科重复就诊和住院天数； 3) 接受 SCA 病症的患者与接受 SC-NA 病症的患者相比，饮酒量减少幅度更大。我们将对干预措施进行成本效益分析。 6 个月和 12 个月的后续评估将通过交互式语音应答 (IVR) 获得。与早期研究相比，当前项目的独特之处包括：1）使用现有的、经过培训的 EP/研究人员； 2）可靠的控制条件，有/没有评估，以测试其对结果的影响； 3) 招募异质的急诊科人群；4) 使用 IVR 促进准确、无偏见的受试者自我报告； 5) 对所测试干预措施的相对经济成本和效益进行分析。