Improving Outcomes for Emergency Department Patients with Alcohol Problems

对退伍军人健康的预期影响：VHA急救服务的可获得性在过去迅速扩大 十年。VHA急诊科(ED)通常是退伍军人经历 与危险饮酒和精神健康问题有关的严重问题。在VHA看到许多退伍军人 EDS报告说，危险的饮酒要么直接与他们的表现问题有关，要么使护理复杂化 医学和/或精神症状。危险饮酒与高饮酒量和高发病率直接相关。 退伍军人的问题，包括创伤后应激障碍、自杀和无家可归。提供简短的酒精干预 这种快节奏的环境可能会因为员工时间需求的竞争而变得困难。扩展同级角色 在VHA中使用的导师在ED中提供简短的酒精建议，并结合ED后的持续支持 旨在减少危险饮酒并帮助退伍军人参与护理的计划有可能填补教育领域的这一空白 照顾和改善弱势群体的结果。项目背景：研究表明， 急诊室就诊的患者中有危险或有害的酒精使用的比例。由于提供商的时间有限， 在急诊室筛查酒精并提供与酒精相关的服务，目前很少有个人获得所需的 在急诊室就诊后，帮助减少饮酒，和/或链接到所需的服务。单会话 酒精短暂干预(BIS)单独在ED中只能适度有效，因此更密集，但 需要可持续的干预措施来促进与最适当的VHA资源的接触(例如， 药物滥用治疗，无家可归者方案病例管理，将心理健康纳入初级保健， 等)。在全国范围内，志愿人员协会在一些领域采用了训练有素的同行专家。VHA EDS 有机会利用同行专家进行标准化的酒精简短干预，提供 继续提供支持，并将退伍军人与所需服务联系起来。在健康范围内广泛使用同龄人 护理团队提供了一种潜在的方法来克服障碍，将退伍军人与危险/有害的人联系起来 酒精使用到需要的VHA服务。项目目标：这项拟议研究的目标是进行 混合随机对照试验，以确定从ED开始的干预的有效性。 提供简短的饮酒建议(包括一个为期6节的基于ED后优势的同伴指导计划) 相比于临床医生在急诊室提供的简短建议，只是为了促进减少危险饮酒，以及 初级和/或专科护理方面的联系和参与。目的1：确定ED酒精的疗效 同伴导师(APM)干预与临床简要建议(CBA)在后续审核分数上的比较， 包括3个月、6个月和12个月的饮酒量/频率、酗酒和饮酒后果 基线后。目的2：确定APM干预对原酒和特制酒关联的影响 基线后3个月、6个月和12个月的治疗服务护理、精神健康症状和功能。 项目方法：拟议的研究将对VA ED患者进行危险饮酒筛查。那些放映 阳性和参加研究的人将被随机分为两种情况之一：1)APM干预(n=225)， 2)CBA(n=225)比较条件。所有参与者都将收到书面的社区资源信息。 所有患有APM的人都将得到同伴支持，以减少危险饮酒，那些 符合酒精使用障碍标准的人将接受同伴的指导，并将帮助温暖地移交给成瘾者 治疗。对退伍军人、同龄人、临床医生和临床领导者的定性访谈将评估 在VHA中实施这一方法的潜在障碍和促进者。因为VHA Ed是一个 进入退伍军人保健系统的重要门户，特别是对于正在经历 危险或有害饮酒，以最低限度的使用提供有效的酒精同伴导师干预 工作人员资源的减少可能会对公共卫生产生重大影响。

Anticipated Impacts on Veteran's Health: The availability of VHA ED care has expanded rapidly over the past decade. VHA Emergency Department (ED) often serves as a first stop for Veterans who are experiencing acute problems related to hazardous alcohol use and mental health problems. Many Veterans seen in VHA EDs report hazardous drinking that is either tied directly to their presenting problem or complicates the care of medical and/or psychiatric symptoms. Hazardous drinking is directly related to high volume and high morbidity problems in Veterans, including PTSD, suicidality and homelessness. Providing alcohol brief interventions in this fast-paced environment can be difficult due to competing staff time demands. Expanding the role of peer mentors used in the VHA to providing brief alcohol advice in the ED combined with post-ED continuing support designed to reduce hazardous drinking and help Veterans engage in care has the potential to fill this gap in ED care and improve outcomes for a vulnerable population. Project Background: Research indicates that a high proportion of patients seen in EDs have hazardous or harmful alcohol use. Due to limited provider time to screen for alcohol and deliver alcohol-related services in EDs, few individuals currently receive the needed assistance to cut-back, stop drinking, and/or link to needed services following an ED visit. Single-session alcohol brief interventions (BIs) alone are only modestly effective in the ED and thus more intensive, but sustainable, interventions are needed to facilitate engagement to the most appropriate VHA resource (e.g., substance abuse treatment, homeless program case management, embedded mental health in primary care, etc.). The VHA nationally has implemented the use of trained peer specialists in a number of areas. VHA EDs have the opportunity to use peer specialists to conduct standardized alcohol brief interventions, provide continuing support, and link Veterans to needed services. The widespread availability of peers within health care teams provides a potential method to overcome barriers for connecting Veterans with hazardous/harmful alcohol use to needed VHA services. Project Objectives: The objective of this proposed study is to conduct a hybrid randomized controlled trial to determine the efficacy of an intervention starting in the ED with peer- delivered brief alcohol advice (including a 6-session program of post-ED strengths-based peer mentorship) compared to clinician-delivered brief advice in the ED only to facilitate reductions in hazardous drinking, and linkage and engagement in primary and/or specialty care. Aim 1: Determine the efficacy of the ED Alcohol Peer Mentor (APM) intervention compared to Clinical Brief Advice (CBA) on subsequent AUDIT scores, including quantity/frequency of alcohol use, binge drinking, and alcohol consequences at 3-, 6-, and 12-months post-baseline. Aim 2: Determine the impact of the APM intervention on linkage to primary and specialty alcohol treatment services care, mental health symptoms and functioning at 3-, 6-, and 12-months post-baseline. Project Methods: The proposed study will screen VA ED patients for hazardous drinking. Those screening positive and who enroll in the study will be randomized to one of two conditions: 1) APM intervention (n=225), and 2) CBA (n=225) comparison condition. All participants will receive written community resource information. All individuals in the APM condition will receive peer support to reduce hazardous drinking, and those who meet alcohol use disorder criteria will be coached by the peer and will assist in a warm handoff to addiction treatment. Qualitative interviews with a subset of Veterans, peers, clinicians, and clinical leaders will assess potential barriers and facilitators to the implementation of this approach in the VHA. Because the VHA ED is an important portal for entry into the VA health care system, particularly for Veterans who are experiencing hazardous or harmful drinking, the delivery of an efficacious alcohol peer-mentor intervention with minimal use of staff resources could have a major public health impact.