Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence

初级保健中不健康饮酒的筛查和管理：PCOR 证据的传播和实施

• 批准号: 10259712
• 负责人: DARREN A DEWALT
• 金额: $ 66.65万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259712
• 关键词: Screening; Management; Unhealthy; Alcohol; Use

Project Summary/Abstract Background: Unhealthy alcohol use is the third leading cause of preventable deaths in the US and is associated with many societal and health problems. It is a key contributor to recent declines in US life expectancy, especially among middle-aged white Americans and those living in rural areas. Despite the burden of illness and recommendations to screen for unhealthy alcohol use, relatively few people who visit primary care providers in the US are asked about alcohol use or ever discuss alcohol use with a health professional. Practices often lack a formal process for screening and subsequent delivery of appropriate interventions. Objectives: The objectives are (1) to determine if primary care practice facilitation (PF) can achieve rapid dissemination and implementation of evidence-based screening, counseling, and medication assisted therapy (MAT) for unhealthy alcohol use and (2) for practices with slower uptake, to compare whether providing embedded telehealth services accelerates the dissemination and implementation of screening, counseling, and MAT. Methods: STUN Alcohol Use Now is an adaptive randomized, controlled trial to evaluate the effect of primary care PF and providing embedded telehealth services on evidence-based screening, counseling, and MAT in 135 primary care practices with 10 or fewer providers. Each enrolled practice will receive the PF intervention. After 6 months of receiving the PF intervention, practices in the lower 50th percentile (based on performance) will be randomized to continued PF or to embedded telehealth services plus PF for the next 12 months. The PF intervention includes onsite QI facilitation, EHR support, training, and academic detailing. Potential Impact: A successful intervention would significantly reduce the burden of disease from unhealthy alcohol use. The study will produce fundamentally important evidence about the effect of practice facilitation on uptake of evidence-based SBI and MAT for unhealthy alcohol use when delivered on a large scale to small to medium-size primary care practices. It will also generate scientific knowledge about whether embedded telehealth services can improve use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by supplying AHRQ with the evidence it needs to effectively and efficiently accelerate the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.

项目摘要/摘要 背景：不健康的饮酒是美国可预防死亡的第三主要原因 并与许多社会和健康问题有关。这是最近的关键因素 美国预期寿命下降，尤其是在中年白人和生活的人中 在农村地区。尽管疾病负担和建议筛查不健康 询问饮酒，访问美国初级保健提供者的人相对较少。 酒精使用或与卫生专业人员讨论酒精使用。练习通常缺乏正式 筛查和随后提供适当干预措施的过程。 目标：目标是（1）确定初级保健实践促进（PF）是否可以 快速传播和实施基于证据的筛查，咨询和 药物辅助疗法（MAT）用于不健康的酒精使用和（2）用于较慢的做法 吸收，比较提供嵌入式远程医疗服务是否会加速 筛选，咨询和垫子的传播和实施。 方法：现在使用昏迷的酒精是一项自适应随机，对照试验，以评估 初级保健PF的影响并提供嵌入式远程医疗服务对循证 在135个初级保健实践中筛查，咨询和垫子，提供10个或更少的提供商。每个 注册的实践将接受PF干预。收到PF 6个月后 干预措施，较低第50个百分位的实践（基于绩效）将随机分配给 在接下来的12个月中，继续使用PF或嵌入了远程医疗服务以及PF。 PF 干预包括现场QI促进，EHR支持，培训和学术细节。 潜在影响：成功的干预将大大减轻疾病的负担 来自不健康的酒精。该研究将产生有关 实践促进的影响对循证SBI和MAT的吸收不健康酒精的影响 当大规模交付到中小型初级保健实践时，请使用。它也会 关于嵌入式远程医疗服务是否可以改善使用的科学知识 基于循证的筛查和干预措施，以减慢吸收。结果的结果 严格进行的评估预计将对AHRQ提供积极影响 它需要有效有效地加速传播和 实施与不健康饮酒有关的证据。