Improving Outcomes for Emergency Department Patients with Alcohol Problems

改善有酒精问题的急诊科患者的治疗效果

• 批准号: 10186527
• 负责人: Frederic C Blow
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186527
• 关键词: Accident and Emergency department; Acute; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohols; Area; Back; Caring; Case Management; Clinical; Communities; Data; Educational Intervention; Emergency Care; Emergency Department patient; Emergency department visit; Emotional; Enrollment; Environment; Frequencies; Health; Health Services Accessibility; Health Services Administration; Healthcare Systems; Homelessness; Human Resources; Hybrids; Individual; Intervention; Interview; Link; Measures; Mediator of activation protein; Medical; Medical Care Team; Medical center; Mental Health; Mental Health Services; Mentorship; Meta-Analysis; Methods; Morbidity - disease rate; Motivation; Outcome; Participant; Patients; Post-Traumatic Stress Disorders; Primary Health Care; Provider; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Research Priority; Resources; Role; Self Efficacy; Services; Social support; Specialist; Standardization; Structure; Suicide; Symptoms; Time; Training; Treatment Efficacy; United States Health Resources Administration; Use Effectiveness; Veterans; Vulnerable Populations; War; addiction; age group; alcohol abuse therapy; alcohol consequences; alcohol intervention; alcohol related consequences; alcohol risk; alcohol screening; alcohol seeking behavior; alcohol use disorder; base; behavior change; binge drinking; brief advice; brief alcohol intervention; brief intervention; care outcomes; care seeking; care systems; cohort; comparison intervention; coping; design; drinking; drinking behavior; evidence base; experience; hazardous drinking; health administration; high risk drinking; improved; improved outcome; intervention effect; medical specialties; outreach; peer; peer coaching; peer support; physical conditioning; programs; psychiatric symptom; role model; screening; service delivery; substance abuse treatment

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.

对退伍军人健康的预期影响：VHA ED护理的可用性在过去迅速扩大 十年。 VHA急诊室（ED）通常是经历经历的退伍军人的第一站 与危险的酒精使用和心理健康问题有关的急性问题。 VHA中看到的许多退伍军人 EDS报告有危险的饮酒直接与他们的提出问题有关，或者使护理复杂化 医学和/或精神病症状。危险饮酒与大容量和高发病率直接相关 退伍军人的问题，包括PTSD，自杀和无家可归。提供酒精短暂的干预措施 由于员工时间的需求，这种快节奏的环境可能很困难。扩大同伴的角色 VHA中使用的导师在ED中提供了简短的酒精建议，并结合了邮政的持续支持 旨在减少危险饮酒并帮助退伍军人参与护理的潜力，有可能填补这一空白 照顾和改善脆弱人群的结果。项目背景：研究表明高 ED中看到的患者比例具有危险或有害的饮酒。由于提供者有限的时间 屏幕酒精并在ED中提供与酒精相关的服务，目前很少有人会收到所需的 ED访问后，协助削减，停止饮酒和/或链接到所需的服务。单节 仅酒精简介干预措施（BIS）仅在ED中有效，因此更密集，但 需要进行可持续的干预措施，以促进最合适的VHA资源（例如， 药物滥用治疗，无家可归的计划案例管理，将心理健康嵌入初级保健中， ETC。）。全国VHA已在许多领域实施了训练有素的同伴专家。 VHA EDS 有机会使用同伴专家进行标准化的酒精简短干预措施，提供 继续支持，并将退伍军人链接到所需的服务。健康中同龄人的广泛可用性 护理团队提供了一种潜在的方法来克服将退伍军人与有害/有害的障碍 酒精用于所需的VHA服务。项目目标：这项拟议的研究的目的是进行 杂交随机对照试验以确定与同行一起在ED中开始的干预措施的功效 提供了简短的酒精建议（包括6条课程的基于后的优势的同伴指导） 与临床医生在急诊室提供的简短建议相比，只是促进危险饮酒的减少和 连接和参与初级和/或专业护理。目标1：确定ED酒精的功效 与随后的审计分数相比，同伴导师（APM）干预与临床简短建议（CBA）相比 包括饮酒的数量/频率，3岁和12个月的酒精饮酒和酒精后果 基线后。 AIM 2：确定APM干预对与初级和特种酒精连接的影响 治疗服务护理，心理健康症状以及3个月和12个月后的功能。 项目方法：拟议的研究将筛查VA ED患者的危险饮酒。那些筛选 阳性和参加研究的人将被随机分为两个条件之一：1）APM干预（n = 225）， 2）CBA（n = 225）比较条件。所有参与者将收到书面社区资源信息。 所有处于APM状态的人都将获得同伴支持以减少危险饮酒，而那些 满足酒精使用障碍标准将由同伴指导，并有助于加热成瘾 治疗。对退伍军人，同伴，临床医生和临床领袖的一部分定性访谈将评估 在VHA中实施这种方法的潜在障碍和促进者。因为vha ed是 进入VA医疗保健系统的重要门户，特别是对于经历的退伍军人 危险或有害饮酒，有效的酒精同伴干预以最少的使用 员工资源可能会产生重大的公共卫生影响。