Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery

优化急诊室的酒精简短干预措施：计算机与临床医生交付

• 批准号: 8115209
• 负责人: Frederic C Blow
• 金额: $ 71.61万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-20 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8115209
• 关键词: AIDS prevention; Accident and Emergency department; Address; Adoption; African American; Age; Alcohol abuse; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Back; Caring; Clinical; Code; Communities; Computers; DSM-IV; Data; Dependence; Detection; Development; Diagnosis; Effectiveness; Elements; Enrollment; Ensure; Equilibrium; Ethnic Origin; Exercise; Feedback; Frequencies; Gender; Goals; HIV; Habits; Health Personnel; Healthcare; Individual; Injury; Inpatients; Intervention; Intervention Studies; Intervention Trial; Location; Mediation; Mediator of activation protein; Medical; Medicare/Medicaid; Meta-Analysis; Methods; Modality; Modeling; Monitor; Motivation; Negative Finding; Outcome; Participant; Patients; Pattern; Primary Health Care; Psyche structure; Public Health; Race; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Regulation; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sampling Studies; Screening procedure; Self Efficacy; Services; Severities; Site; Structure; Subgroup; System; Tablets; Technology; Testing; Time; Training; Translating; Trauma; United States; Visit; Writing; alcohol abuse therapy; alcohol consequences; alcohol misuse; alcohol related consequences; alcohol related problem; alcohol screening and brief intervention; alcohol use disorder; base; brief alcohol intervention; brief intervention; brief motivational intervention; care systems; clinical practice; comparative efficacy; computer generated; computerized; design; drinking; evidence base; experience; improved; inner city; innovation; intervention effect; laptop; longitudinal design; low socioeconomic status; meetings; motivational enhancement therapy; physical conditioning; prevent; programs; public health relevance; reduced alcohol use; research study; screening, brief intervention, referral, and treatment; sex; skills; substance abuse treatment; technological innovation; therapy design; touchscreen; trauma centers; treatment as usual; trial comparing; underage drinker

DESCRIPTION (provided by applicant): Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or problem alcohol use, few are screened and receive services such as brief interventions (BI) designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious and effective in a variety of health care settings. However, the evidence for their use in the ED has been mixed. There is a pressing need to develop efficacious strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing clinician-delivered BI strategies need to be modified so that they can be standardized and administered with high fidelity and minimal demands on ED staff time and resources. Computer-delivered BIs are one method to address the challenges inherent in delivering interventions in this and other healthcare settings. The proposed study will use computerized screening via touch-screen computer tablets with audio to recruit 750 inner-city ED patients screening positive for at-risk or problem alcohol use. Participants age 18-60 will be randomized to one of three conditions: 1) Computer-delivered brief intervention (C-BI; n=250); 2) Therapist-delivered brief intervention (T-BI; n=250); or 3) Enhanced usual care (EUC; n=250). All participants will receive written information regarding community resources; individuals who meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals. Stratified random assignment [by gender; meeting criteria for an alcohol use disorder - yes/no] will take place at baseline for all conditions. The aims of the study are to develop and refine tailored motivational brief interventions that are parallel in structure but have varied delivery modalities (computer vs. therapist) for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled trial comparing the efficacy of these BI approaches (C-BI, T-BI, control) on subsequent alcohol consumption and alcohol consequences, including alcohol-related injury, mental and physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit. The rigorous examination of the efficacy of therapist- vs. computer- delivered BIs, including potential moderators and mediators, will address the key limitations raised by previous trials and will determine the optimal modality for wide implementation of brief alcohol interventions in this venue. Because the ED is such an important portal for entry into the medical care system, particularly for inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational interviewing components and minimize staff resources could have a major public health impact. PUBLIC HEALTH RELEVANCE: Few people who misuse alcohol and who might benefit from brief motivational interventions actually receive them. The inner city Emergency Department (ED) is an ideal location in which to implement screening, brief interventions, and referral to treatment, where needed, for alcohol misuse because of the heterogeneous proportion of patients in these settings who misuse alcohol.

描述（由申请人提供）：尽管在急诊科（EDS）中看到的患者中有很大比例的患者有危险或饮酒问题，但很少有筛查并接受诸如旨在帮助他们削减或停止饮酒的短暂干预措施（BI）。 EDS不能常规地提供BIS，这可能是由于可行性挑战，例如培训员工，监视保真度和维护系统以确保长期实施。在各种医疗保健环境中，已经发现酒精二醇二是有效且有效的。但是，在ED中使用的证据已混合在一起。在此快节奏且广泛使用的环境中，需要制定有效的策略来制定有效的策略，以筛选并最佳地提供酒精二。需要修改现有的临床医生提供的BI策略，以便可以通过高保真度和对ED员工时间和资源的最小要求进行标准化和管理。计算机交付的bis是解决在此和其他医疗机构中提供干预措施固有的挑战的一种方法。拟议的研究将使用带有音频的触摸屏计算机平板电脑使用计算机化筛查，以招募750名内城ED患者，筛查对高危或饮酒问题的阳性。 18-60岁的参与者将被随机分为三个条件之一：1）计算机交付的简短干预（C-BI; n = 250）; 2）治疗师进行了简短干预（T-BI; n = 250）;或3）增强常规护理（EUC; n = 250）。所有参与者将收到有关社区资源的书面信息；符合酒精滥用/依赖标准的个人也将接受酒精治疗转诊。分层随机分配[通过性别；满足酒精使用障碍的标准 - 是/否]将在所有条件下在基线上进行。该研究的目的是开发和完善量身定制的动机短暂干预措施，这些干预措施在结构上平行，但对于有危险或有问题的饮酒的患者具有多样化的交付方式（计算机与治疗师），并进行了随机对照试验，并进行随后的BI方法（C-BI，T-BI，对照，饮酒）的效果，并进行了饮酒和饮酒的功能，并进行了饮酒的功能，并进行了饮酒，并进行了良好的饮酒效果，并伴随着饮酒效果，并具有良好的饮酒效果。 3，6个和12个月后的行为访问。严格检查治疗师与计算机交付的BI的功效，包括潜在的主持人和调解人，将解决以前试验提出的关键局限性，并将确定在本场所中大量实施短暂酒精干预措施的最佳方式。由于急诊室是进入医疗系统（尤其是城市内城患者）的重要门户，因此强调关键动机访谈组件并最大程度地减少员工资源的有效酒精二氧化碳的交付可能会产生重大的公共卫生影响。 公共卫生相关性：很少有滥用酒精并可能从短暂的动机干预措施中受益的人实际上得到了它们。城市急诊室（ED）是一个理想的地理位置，可以在需要筛查，简短的干预措施以及在需要时转介治疗，以滥用酒精，因为这些情况下滥用酒精的患者的异质比例是异质的。