Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial.
Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial.
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DOI：
10.1186/s13722-015-0047-0
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发表时间：
2015-11-19
影响因子：
3.7
通讯作者：
Sterling SA
中科院分区：
文献类型：
--
作者：
Mertens JR;Chi FW;Weisner CM;Satre DD;Ross TB;Allen S;Pating D;Campbell CI;Lu YW;Sterling SA
不健康的饮酒是造成全球疾病和伤害负担的主要因素。自2004年以来，美国预防服务工作组建议在一般医疗环境中进行酒精筛查和干预。然而，不到六分之一的美国成年人报告说，医疗保健专业人员与他们讨论酒精。对加强执行的方法知之甚少;不同的人员配置模式可能与执行效力有关。这项实施试验比较了医生与接受培训、技术援助和反馈报告的非医生提供者提供的酒精筛查、简短干预和转介专科治疗（SBIRT）。这项研究是一项随机分组实施试验（ADVISe [饮酒作为生命体征]）。在一个私人的综合医疗保健系统中，54个成人初级保健诊所按医疗中心分层，并随机分为三个封闭组，由医生（PCP组）与非医生提供者和医疗助理（NPP和MA组），与常规护理（对照组）进行SBIRT。NIH推荐的筛查问题已添加到电子健康记录（EHR）中，以促进SBIRT。我们检查了筛查率、短期干预率和转诊率，还检查了影响筛查率的患者、医生和系统水平的因素，以及在筛查阳性者中，短期干预率和转诊率。NPP和MA组的筛查率最高（51%）;其次是PCP组（9%）和对照组（3.5%）。NPP和MA组在培训后的12个月内筛查增加，但PCP组保持稳定。在筛查阳性患者中，PCP组的短期干预和转诊率（44%）高于NPP和MA组（3.4%）或对照组（2.7%）。较高的比例的MA的医生与较高的筛查率在NPP和MA臂和较长的预约时间，以筛选和干预率在PCP arm. Findings结果表明，可能需要超过12个月的时间框架，全面SBIRT的实施。在目前占主导地位的初级保健模式中，由医学助理进行筛查，并根据需要由医生进行干预和转诊，可以成为一种可行的模式，以增加这一关键和利用不足的预防性卫生服务的实施。试验注册：临床试验NCT 01135654
Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US adults report health care professionals discussing alcohol with them. Little is known about methods for increasing implementation; different staffing models may be related to implementation effectiveness. This implementation trial compared delivery of alcohol screening, brief intervention and referral to specialty treatment (SBIRT) by physicians versus non-physician providers receiving training, technical assistance, and feedback reports. The study was a cluster randomized implementation trial (ADVISe [Alcohol Drinking as a Vital Sign]). Within a private, integrated health care system, 54 adult primary care clinics were stratified by medical center and randomly assigned in blocked groups of three to SBIRT by physicians (PCP arm) versus non-physician providers and medical assistants (NPP and MA arm), versus usual care (Control arm). NIH-recommended screening questions were added to the electronic health record (EHR) to facilitate SBIRT. We examined screening and brief intervention and referral rates by arm. We also examined patient-, physician-, and system-level factors affecting screening rates and, among those who screened positive, rates of brief intervention and referral to treatment. Screening rates were highest in the NPP and MA arm (51 %); followed by the PCP arm (9 %) and the Control arm (3.5 %). Screening increased over the 12 months after training in the NPP and MA arm but remained stable in the PCP arm. The PCP arm had higher brief intervention and referral rates (44 %) among patients screening positive than either the NPP and MA arm (3.4 %) or the Control arm (2.7 %). Higher ratio of MAs to physicians was related to higher screening rates in the NPP and MA arm and longer appointment times to screening and intervention rates in the PCP arm. Findings suggest that time frames longer than 12 months may be required for full SBIRT implementation. Screening by MAs with intervention and referral by physicians as needed can be a feasible model for increasing the implementation of this critical and under-utilized preventive health service within currently predominant primary care models. Trial registration: Clinical Trials NCT01135654