Decreasing the Engagement Gap for Addiction Treatment in Primary Care

项目摘要 意义重大。酒精使用障碍(AUD)很常见，费用很高，而且会危及生命，但只有8/100 患有过去一年澳门氏症的患者将接受治疗。大多数患有AUDS的人去初级保健中心就诊，并倾向于 在初级保健中接受AUD治疗。这代表着错失了机会。 职业发展计划。格拉斯博士是一名临床研究人员，他成功地回答了 通过分析复杂的二级数据集来研究问题。他的长期目标是进行干预 在初级保健方面进行试验，以扩大成瘾治疗的覆盖面和影响。拟建的K01 职业发展奖将确保他获得指导、培训和研究经验 实现这一目标所需要的。因为新的移动健康(MHealth)计划提供了相对新颖的-和 潜在的成本效益和可伸缩性-将有效的AUD治疗范围扩大到 初级保健，格拉斯博士将把他的培训重点放在数据收集和准备一项有效性试验上 有望为AUDS患者提供mHealth干预。这将使他准备好领导严格的、最先进的 在初级保健中进行澳元病干预试验，并确保他发挥其作为澳元病研究领先者的潜力。 研究计划。格拉斯博士提议的研究将评估现有的 MHealth工具(Square2)作为初级保健中管理AUDS的新选项。Square2计划包括 几种基于证据的电子工具，用于成瘾治疗和相关的共病(抑郁症， 焦虑和烟草使用)，旨在满足初级保健患者的需求，无论他们 AUD严重性或改变的准备。然而，Square2尚未在初级保健或 对于AUD治疗，需要进行开发研究，以确定参与 平方试验中AUDS患者的概括性初级保健样本2。建议的具体目标 K01是：(目标1)评估患有AUDS的初级保健患者和护理他们的临床医生的需求 将mHealth作为AUDS初级保健管理的一部分(n=40)；以及(目标2)试点随机 对照试验(RCT)，通过评估a)的可行性和可接受性，为未来的有效性试验提供信息 在临床医生的帮助下在初级保健中提供Square2，以及b)随机对照试验设计的可行性(n=60)。 导师关系和环境。初级保健AUDS方面的专家调查员(初级导师布拉德利博士)； MHealth(共同导师Marsch和McClure博士)；数据收集(共同导师Curran博士)；以及务实试验 (顾问西蒙博士)将支持这项研究。这项研究将在团体健康研究中心进行 该研究所是一家创新的研究机构，嵌入了太平洋西北部的一个大型初级保健系统。 对公众健康的影响：拟议的活动将确保Glass博士发展成为一个创新的 独立研究人员。此外，拟议的研究将为未来mHealth的R01奠定基础 扩大有效的AUD治疗范围的工具，从而改善AUDS患者的预后。

Project Summary Significance. Alcohol use disorders (AUDs) are common, costly, and life-threatening, but just 8 in 100 people with a past-year AUD receive treatment. Most individuals with AUDs visit primary care and prefer to receive AUD treatment in primary care. This represents a missed opportunity. Career Development Plan. Dr. Glass is a clinician researcher who has successfully answered important research questions by analyzing complex secondary datasets. His long-term goal is to conduct intervention trials in primary care in order to increase the reach and impact of addiction treatment. The proposed K01 career development award will ensure that he receives the mentoring, training, and research experience needed to achieve this goal. Because new mobile health (mHealth) programs offer a relatively novel—and potentially cost-effective and scalable—approach to increasing the reach of effective AUD treatments into primary care, Dr. Glass will focus his training on data collection and preparing for an effectiveness trial of a promising mHealth intervention for patients with AUDs. This will prepare him to lead rigorous, state-of-the-art trials of AUD interventions in primary care, and ensure he reaches his potential as a leader in AUD research. Research Plan. Dr. Glass's proposed research will evaluate the feasibility and acceptability of an existing mHealth tool (Square2) as a new option for managing AUDs in primary care. The Square2 program includes several evidence-based electronic tools for addiction treatment and associated comorbidity (depression, anxiety and tobacco use), and is designed to address the needs of primary care patients irrespective of their AUD severity or readiness to change. However, Square2 has not yet been empirically tested in primary care or for AUD treatment, and developmental research is needed to identify the optimal approach to engaging a generalizable primary care sample of patients with AUDs in a trial of Square2. Specific aims for the proposed K01 are: (Aim 1) Assess the needs of primary care patients with AUDs, and clinicians who care for them, for use of mHealth as part of primary care management of AUDs (n = 40); and (Aim 2) Pilot a randomized controlled trial (RCT) to inform a future effectiveness trial by assessing a) the feasibility and acceptability of delivering Square2 in primary care with clinician assistance, and b) the feasibility of the RCT design (n = 60). Mentorship and Environment. Expert investigators in AUDs in primary care (Primary Mentor Dr. Bradley); mHealth (Co-Mentors Drs. Marsch and McClure); data collection (Co-Mentor Dr. Curran); and pragmatic trials (advisor Dr. Simon) will support this research. The research will be conducted at the Group Health Research Institute, an innovative research institution embedded in a large primary care system in the Pacific Northwest. Public Health Impact: The proposed activities will ensure the development of Dr. Glass into an innovative independent researcher. Moreover, the proposed research will lay the groundwork for future R01s of mHealth tools to increase the reach of effective AUD treatments, thereby improving outcomes for patients with AUDs.