Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial.
Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial.
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DOI：
10.1016/j.cct.2022.107004
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发表时间：
2022-12
影响因子：
2.2
通讯作者：
Sterling, Stacy A.
中科院分区：
文献类型：
--
作者：
Metz, Verena E.;Leibowitz, Amy;Satre, Derek D.;Parthasarathy, Sujaya;Jackson-Morris, Melanie;Cocohoba, Jennifer;Sterling, Stacy A.
关键词：
酒精使用问题与严重的医疗、心理健康和社会经济后果有关。然而，即使在医疗机构中发现了患者，大多数人也没有接受治疗，并且很少使用药物治疗。这项研究将测试酒精远程医疗咨询（ATC）服务的有效性，这是一种针对酒精使用问题的初级保健患者的新型个性化远程医疗干预方法。这项随机分组的实用性试验，辅以定性访谈，将包括在21年9月10日至23年3月10日期间从Kaiser Permanente北方加州两个大型城市医疗中心的16个初级保健诊所进行初级保健访问的成年人，这是一个大型综合医疗保健系统。诊所被随机分配到ATC服务（干预），包括酒精药物治疗和SBIRT（筛选，基于MI（动机性访谈）的简短干预和转介成瘾治疗），由临床药剂师提供，或提供系统性酒精SBIRT的家庭护理（UC）部门。主要结局包括ATC和UC组在1）实施结局（酒精药物治疗处方率，专业成瘾治疗转诊）和2）1.5年内患者结局（药物填充，成瘾治疗开始，酒精使用，医疗保健服务利用）方面的比较。一般建模方法将考虑患者/提供者的聚类，随机效应模型将考虑提供者和诊所内患者之间的类内相关性。与提供者的定性访谈将审查实施的障碍和促进因素。ATC研究检查了药剂师提供的远程医疗干预措施的有效性，该干预措施结合了药物治疗和基于MI的咨询。如果有效，ATC研究可能会影响整个酒精使用问题的治疗模式。
Alcohol use problems are associated with serious medical, mental health and socioeconomic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of the Alcohol Telemedicine Consult (ATC) Service, a novel, personalized telehealth intervention approach for primary care patients with alcohol use problems. This cluster-randomized pragmatic trial, supplemented by qualitative interviews, will include adults with a primary care visit between 9/10/21-3/10/23 from 16 primary care clinics at two large urban medical centers within Kaiser Permanente Northern California, a large, integrated healthcare system. Clinics are randomized to the ATC Service (intervention), including alcohol pharmacotherapy and SBIRT (screening, MI (Motivational Interviewing)-based brief intervention and referral to addiction treatment) delivered by clinical pharmacists, or Usual Care (UC) arm that provides systematic alcohol SBIRT. Primary outcomes include a comparison of the ATC and UC arms on 1) implementation outcomes (alcohol pharmacotherapy prescription rates, specialty addiction treatment referrals); and 2) patient outcomes (medication fills, addiction treatment initiation, alcohol use, healthcare services utilization) over 1.5 years. A general modeling approach will consider clustering of patients/providers, and a random effects model will account for intra-class correlations across patients within providers and across clinics. Qualitative interviews with providers will examine barriers and facilitators to implementation. The ATC study examines the effectiveness of a pharmacist-provided telehealth intervention that combines pharmacotherapy and MI-based consultation. If effective, the ATC study could affect treatment models across the spectrum of alcohol use problems.
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