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.

危险酒精和药物使用以及酒精和物质使用障碍 (AUD/SUD) 的比例最高 与生命历程的其他时期相比，育龄期的妇女。 与重要的终生行为、心理、身体、性和生殖健康 (SRH) 相关 对妇女的影响，尤其是对种族和族裔少数群体的妇女和生活在其中的人的影响 迫切需要创新方法来解决预防性饮酒和药物滥用问题。 计划生育 (FP) 诊所是值得信赖的护理来源和主要访问点。 美国 FP 诊所为女性提供服务，并为结构性边缘化群体提供安全网。 适合但完全未被充分研究的实施和扩展综合酒精/药物使用服务的环境。 虽然筛查、简短干预和转诊治疗 (SBIRT) 是一种被广泛接受的、基于证据的方法 对于初级保健和心理健康机构中酒精使用的干预措施，人们对促进者和 FP 诊所采用和维持 SBIRT 的障碍对于远程医疗的了解甚至更少。 作为 SBIRT 交付平台，它已针对 COVID-19 迅速推出。此外，几乎没有证据。 存在有效的组织层面战略实施，以加速 SBIRT 在 FP 中的采用。 我们提出了一项解释性、顺序、混合方法研究来评估扩展 FP 中的 SBIRT 国家性健康与保健组织的诊所网络——一个新颖且极具影响力的环境，覆盖多元化的人群 以及 AUD/SUD 风险最大的育龄妇女等社会弱势群体。 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），以实施研究综合框架为指导 达到、有效性、采用、实施和维护模型在目标 1 中确定具体目标。 为了实施、维持和扩大 SBIRT，我们将与诊所进行行政调查 利益相关者（诊所主任、提供者和工作人员 n=153）以及与利益相关者和关键信息人士的访谈 患者 (n=40) 调查有关酒精和物质相关的组织实践和观点 在目标 2 中，我们将进行双随机 1 类混合有效性-实施试验测试。 SBIRT（现场和远程医疗）与常规护理，在大型、高容量的东北部附属机构内进行 我们将随机抽取 4 个诊所的 600 名患者，收集患者的酒精水平数据。 和物质使用的主要有效性结果，以及次要的 SRH、心理/身体健康、质量 目标 3 将探索促进因素和障碍。 通过调查和采访诊所主任来了解 SBIRT 的采用和 ISF 实施策略， 提供者、工作人员 (n=20) 和患者 (n=20) 电子医疗记录将提供新的、及时的记录。 为在全国计划生育机构中扩大酒精和药物相关服务提供信息的证据。