Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care.
Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care.
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DOI：
10.3390/ijerph14091030
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发表时间：
2017-09-08
影响因子：
--
通讯作者：
Bradley KA
中科院分区：
文献类型：
--
作者：
Bobb JF;Lee AK;Lapham GT;Oliver M;Ludman E;Achtmeyer C;Parrish R;Caldeiro RM;Lozano P;Richards JE;Bradley KA
酒精使用是全世界残疾和死亡的主要原因。为了改善对不健康饮酒的预防和治疗，专家建议将与酒精相关的护理纳入初级保健（PC）。然而，很少有医疗保健系统这样做。为了解决这一差距，Kaiser Permanente华盛顿的实施研究人员和临床领导者合作设计了一个高质量的持续以患者为中心的酒精相关护理计划（Patient-Centered Alcohol-Related Care，简称CME）。在这里，我们描述了可持续发展的试点实施，评估其有效性在三个大型试点网站，并描述了定性的研究结果的障碍和促进因素。在三个研究中心（N = 74，225例PC患者）中，酒精筛查从实施前的8.9%增加到实施后的62%（p < 0.0001），酒精使用障碍（AUD）评估相应增加，从每10，000例患者1.2增加到75例（p < 0.0001）。一年后持续增加，筛查率为84.5%，所有研究中心的评估率为每10，000例患者81例。此外，新的AUD诊断数量增加了50%（p = 0.0002），新诊断后14天内治疗增加了54%（p = 0.083），无统计学意义。试点通知正在进行的阶梯楔形试验在其余22个PC网站。
Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.
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影响因子：
39.2
作者：
Bryson, Chris L.;Au, David H.;Bradley, Katharine A.
通讯作者：
Bradley, Katharine A.
影响因子：
5.7
作者：
Ahmed, Ameena T.;Karter, Andrew J.;Weisner, Constance M.
通讯作者：
Weisner, Constance M.
影响因子：
5.7
作者：
Glass, Joseph E.;Bohnert, Kipling M.;Brown, Richard L.
通讯作者：
Brown, Richard L.
DOI：
10.1111/j.1530-0277.2012.01887.x
发表时间：
2013-01-01
影响因子：
3.2
作者：
Glass, Joseph E.;Kristjansson, Sean D.;Bucholz, Kathleen K.
通讯作者：
Bucholz, Kathleen K.
影响因子：
3.8
作者：
Bradley, Katharine A.;Chavez, Laura J.;Kivlahan, Daniel R.
通讯作者：
Kivlahan, Daniel R.