Systematic Implementation of Patient-centered Care for Alcohol Use Trial: Beyond Referral to Treatment

系统实施以患者为中心的饮酒护理试验：超越转诊治疗

基本信息

批准号：
10776775
负责人：
KATHARINE ANTHONY BRADLEY
金额：
$ 74.96万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10776775
关键词：
Address Adoption Adult Agreement Alcohol consumption Alcoholics Anonymous Alcohols Caring Cessation of life Clinic Clinical Counseling DSM-V Decision Aid Diagnosis Effectiveness Electronic Health Record Eligibility Determination Hybrids Individual International Intervention Label Language Measures Medical Medical Records National Committee for Quality Assurance National Institute on Alcohol Abuse and Alcoholism Outcome Pamphlets Patient Self-Report Patient-Centered Care Patients Persons Pharmaceutical Preparations Play Population Intervention Prevalence Primary Care Provider Public Health Randomized Recommendation Recovery Reporting Research Resources Role Sampling Social Workers Stigmatization Support Groups Surveys Symptoms Testing Thinking Time Visit Washington alcohol abuse therapy alcohol screening alcohol use disorder arm barrier to care comparison intervention coronavirus disease disability drinking effective therapy effectiveness-implementation randomized trial effectiveness/implementation trial experience follow-up implementation evaluation implementation facilitators implementation intervention implementation outcomes outreach patient engagement patient oriented peer support population based pragmatic trial preference pressure primary care clinic primary care patient primary care provider primary care team primary outcome randomized trial screening screening, brief intervention, referral, and treatment secondary outcome shared decision making social stigma therapy design treatment arm treatment as usual treatment program trial comparing usual care arm web site

Address Adoption Adult Agreement Alcohol consumption Alcoholics Anonymous Alcohols Caring Cessation of life Clinic Clinical Counseling DSM-V Decision Aid Diagnosis Effectiveness Electronic Health Record Eligibility Determination Hybrids Individual International Intervention Label Language Measures Medical Medical Records National Committee for Quality Assurance National Institute on Alcohol Abuse and Alcoholism Outcome Pamphlets Patient Self-Report Patient-Centered Care Patients Persons Pharmaceutical Preparations Play Population Intervention Prevalence Primary Care Provider Public Health Randomized Recommendation Recovery Reporting Research Resources Role Sampling Social Workers Stigmatization Support Groups Surveys Symptoms Testing Thinking Time Visit Washington alcohol abuse therapy alcohol screening alcohol use disorder arm barrier to care comparison intervention coronavirus disease disability drinking effective therapy effectiveness-implementation randomized trial effectiveness/implementation trial experience follow-up implementation evaluation implementation facilitators implementation intervention implementation outcomes outreach patient engagement patient oriented peer support population based pragmatic trial preference pressure primary care clinic primary care patient primary care provider primary care team primary outcome randomized trial screening screening, brief intervention, referral, and treatment secondary outcome shared decision making social stigma therapy design treatment arm treatment as usual treatment program trial comparing usual care arm web site

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项目摘要

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. SUMMARY. About 14% of US adults have an active alcohol use disorder (AUD) and most never receive treatment. Experts agree primary care should play a major role in identifying AUD and engaging patients in treatment. However, screening, brief intervention and referral to treatment (SBIRT) alone has not been found to increase AUD treatment. High-quality patient-centered primary care usually relies on shared decision-making, which can help motivate patients and support them in finding treatments that are aligned with their preferences. While patients likely prefer shared decision-making with their primary care providers, time pressures and other barriers in primary care may limit the reach of shared decision-making in primary care; centralized approaches with systematic outreach could decrease the burden on primary care and have greater reach, but it is unknown whether shared decision-making for AUD will be effective in the absence of an established clinical relationship. SPECIFIC AIMS: The Systematic Implementation of Patient-centered Care for Alcohol Use Trial is a pragmatic, cluster-randomized, effectiveness-implementation trial testing two interventions to systematically implement shared decision-making with primary care patients with AUD: a primary care intervention and a centralized intervention. The specific aims of the trial are to test whether each intervention—compared to usual care alone—(1) increases the proportion of primary care patients engaged in AUD treatment over a year follow-up or (2) decreases alcohol use over 2 years follow-up. METHODS: The proposed trial is conducted in 30 primary care clinics in which usual care includes SBIRT. The trial randomizes the 30 clinics to one of three approaches to managing AUD: (1) usual care; (2) a primary care intervention added to usual care that uses state-of-the-art implementation interventions to systematically encourage primary care providers to offer routine shared decision-making for AUD; and (3) a centralized intervention added to usual care that systematically offers outreach and shared decision-making for AUD by a social worker. The trial sample includes 1,500 adult primary care patients who are at high-risk for moderate-severe AUD based on DSM-5 AUD symptoms documented in their medical records. Primary outcomes are: 1) the prevalence of documented AUD treatment engagement during 12 months of follow-up per National Committee for Quality Assurance (NCQA) definitions (2 visits for AUD treatment in the 34 days after initiation), and 2) changes in alcohol use at follow-up screening based on changes in the AUDIT-C score from baseline to follow-up 9-24 months later (irrespective of treatment engagement). Intent to treat analyses include all eligible patients regardless of whether they receive shared decision-making and compare patients in each intervention arm to those in the usual care arm. IMPACT: Over 32 million US adults have active AUD. Many are identified in primary care but few engage in referrals to treatment. This trial will test two practical population-based interventions to increase treatment engagement in patients who report AUD symptoms.

在此处输入文本，这是您应用程序的新摘要信息。本节必须不超过30行文本。概括。美国大约14％的成年人患有活跃的酒精饮酒障碍（AUD），并且大多数从未接受过治疗。专家认为，初级保健应在识别AUD和吸引患者参与治疗方面发挥重要作用。但是，尚未发现筛查，简短的干预和转介到治疗（SBIRT）可以增加AUD治疗。高质量的以患者为中心的初级保健通常依赖共同的决策，这可以帮助激励患者并支持他们寻找与他们的偏好保持一致的治疗方法。尽管患者可能更喜欢与初级保健提供者共享决策，但时间压力和初级保健的其他障碍可能会限制初级保健中共同决策的范围；具有系统外展的集中式方法可能会减少伯恩在初级保健方面，并具有更大的影响力，但是在没有建立的临床关系的情况下，AUD的共同决策是否会有效。具体目的：以患者为中心的酒精使用试验的系统实施是一项务实的，聚类的，有效性实施试验，测试了两项干预措施，以系统地与AUD的初级保健干预措施进行系统地实施共同的决策：一项初级保健干预措施和集中的干预措施。该试验的具体目的是测试每种干预措施（仅与通常的护理相关）（1）（1）增加一年随访中从事AUD治疗的初级保健患者的比例或（2）在2年的随访中降低酒精的使用。方法：拟议的试验是在30个初级保健诊所进行的，在该诊所中，通常的护理包括SBIRT。该试验将30个诊所随机使用到管理AUD的三种方法之一：（1）通常的护理；（2）在通常的护理中添加了初级保健干预措施，该干预使用最先进的实施干预措施系统地鼓励初级保健提供者为AUD提供常规的共享决策；（3）在通常的护理中增加了集中的干预措施，该干预系统地为社会工作者提供了宣传和共同的决策。试验样本包括1,500名基于病历中记录的DSM-5 AUD符号的中度重度AUD高风险的成人初级保健患者。主要结果是：1）每个国家质量保证委员会（NCQA）定义的随访12个月的AUD治疗参与度的流行（在启动后34天内进行了2次AUD治疗访问），而2）基于随访筛查中酒精使用的变化，基于审核-C分数的变化，从基线到9-24个月的后续审查（以后的9-24个月），以后的治疗疗法（无论是在接受治疗时）。治疗分析的意图包括所有合格的患者，无论他们是否接受共同的决策，并将每个干预臂中的患者与通常的护理部门的患者进行比较。影响：超过3200万美国成年人有活跃的AUD。许多在初级保健中被发现，但很少有人转介治疗。该试验将测试两种基于人群的干预措施，以增加报告AUD症状的患者的治疗参与。