Improving Outcomes for Emergency Department Patients with Alcohol Problems

对退伍军人健康的预期影响：VHA艾德护理的可用性在过去迅速扩大 十年VHA急诊部（艾德）经常作为第一站的退伍军人谁是经历 与危险饮酒有关的严重问题和心理健康问题。许多退伍军人在VHA看到 ED报告危险饮酒，这要么直接与他们目前的问题有关，要么使护理复杂化。 医学和/或精神症状。危险饮酒与高容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。提供酒精简短干预， 这种快节奏的环境可能很困难，因为工作人员的时间需求相互竞争。扩大同行的作用 VHA中使用的导师在艾德中提供简短的酒精建议，并结合艾德后的持续支持 旨在减少危险饮酒和帮助退伍军人从事护理有可能填补这一空白，艾德 关心和改善弱势群体的成果。项目背景：研究表明， 在急诊室就诊的患者中，有一定比例的人使用了危险或有害的酒精。由于供应商时间有限， 筛查酒精并在急诊室提供与酒精相关的服务，目前很少有人接受所需的 协助减少，停止饮酒，和/或链接到所需的服务后，艾德访问。单场次 酒精短暂干预（BI）单独在艾德中仅适度有效，因此更密集，但 可持续的，需要采取干预措施，以促进最适当的VHA资源（例如， 药物滥用治疗，无家可归者项目案例管理，初级保健中的嵌入式心理健康， 等）。VHA在全国范围内已在一些领域使用经过培训的同行专家。VHA ED 有机会使用同行专家进行标准化的酒精简短干预，提供 继续支持，并将退伍军人与所需的服务联系起来。在卫生领域广泛存在的同行 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 酒精使用需要VHA服务。项目目标：这项拟议研究的目标是进行一项 混合随机对照试验，以确定从艾德开始的干预措施的有效性， 提供简短的酒精建议（包括6个会议的ED后基于力量的同伴指导计划） 与临床医生在艾德提供的简短建议相比，仅有助于减少危险饮酒， 联系和参与初级和/或专科护理。目的1：确定艾德酒精的有效性 同伴指导（APM）干预与临床简要建议（CBA）对后续AUDIT评分的影响比较， 包括3个月、6个月和12个月时的饮酒量/频率、酗酒和酒精后果 基线后。目标2：确定APM干预措施对与初级酒精和特种酒精联系的影响 基线后3个月、6个月和12个月的治疗服务护理、心理健康症状和功能。 项目方法：本研究将筛选VA艾德患者的危险饮酒。那些筛选 阳性并且参加研究的患者将被随机分配到以下两种情况之一：1）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。 所有处于APM状态的人都将得到同伴的支持，以减少危险饮酒， 符合酒精使用障碍的标准将由同行指导，并将协助在一个温暖的交接成瘾 治疗对退伍军人、同行、临床医生和临床领导者的一部分进行定性访谈， 在VHA中实施该方法的潜在障碍和促进因素。因为VHA艾德是一个 进入VA医疗保健系统的重要门户，特别是对于正在经历 危险或有害的饮酒，提供有效的酒精同行导师干预，最小限度地使用 人力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.