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: 10271303
• 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 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10271303
• 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; Veterans Health Administration; 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; high risk drinking; implementation facilitators; 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 急诊护理的可用性在过去迅速扩大 十年。 VHA 急诊室 (ED) 通常是遇到困难的退伍军人的第一站 与危险饮酒和心理健康问题有关的严重问题。许多退伍军人在 VHA 中见到 急诊室报告危险饮酒，这要么与他们目前的问题直接相关，要么使护理变得复杂 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。提供酒精短暂干预 由于员工的时间需求相互竞争，这种快节奏的环境可能会很困难。扩大同伴的作用 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设计有可能填补急诊科的这一空白 照顾弱势群体并改善其结果。项目背景：研究表明，高 急诊科就诊的患者中有一部分有危险或有害的饮酒行为。由于供应商时间有限 在急诊室进行酒精筛查并提供与酒精相关的服务，目前很少有人获得所需的服务 急诊就诊后协助减少饮酒、戒酒和/或联系所需的服务。单次会议 单独的酒精短期干预 (BI) 在急诊科中效果有限，因此强度更大，但 为了可持续，需要采取干预措施来促进参与最合适的 VHA 资源（例如， 药物滥用治疗、无家可归者计划案例管理、将心理健康纳入初级保健、 ETC。）。 VHA 在全国范围内已在多个领域使用经过培训的同行专家。 VHA ED 有机会利用同行专家进行标准化酒精简短干预，提供 持续支持，并将退伍军人与所需的服务联系起来。卫生领域内同行的广泛存在 护理团队提供了一种潜在的方法来克服将退伍军人与危险/有害人员联系起来的障碍 饮酒以获取所需的 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，以确定从急诊室开始与同行进行干预的效果 提供简短的饮酒建议（包括 6 个 ED 后基于优势的同伴指导计划） 与临床医生在急诊室提供的简短建议相比，只是为了减少危险饮酒，以及 初级和/或专科护理中的联系和参与。目标 1：确定 ED 酒精的功效 同行导师 (APM) 干预与临床简报建议 (CBA) 对后续 AUDIT 评分的干预进行了比较， 包括饮酒量/频率、酗酒以及 3 个月、6 个月和 12 个月时的酒精后果 基线后。目标 2：确定 APM 干预对初级酒精和特种酒精联系的影响 治疗服务包括基线后 3、6 和 12 个月的护理、心理健康症状和功能。 项目方法：拟议的研究将对 VA ED 患者进行有害饮酒筛查。那些筛选 阳性且参加研究的人将被随机分配到以下两种条件之一：1) 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 状况的个人都将获得同伴支持，以减少危险饮酒，并且那些 符合酒精使用障碍标准，将接受同伴的指导，并协助热情地摆脱成瘾 治疗。对退伍军人、同行、临床医生和临床领导者的定性访谈将评估 在 VHA 中实施该方法的潜在障碍和促进因素。因为 VHA ED 是 进入 VA 医疗保健系统的重要门户，特别是对于正在经历的退伍军人 危险或有害饮酒，以最少的使用提供有效的酒精同伴指导干预 人力资源可能对公共卫生产生重大影响。