Multi-site Pilot Trial of Strengths-based Linkage to Alcohol Care (SLAC) for Hazardous Drinkers in Primary Care

针对初级保健中危险饮酒者的基于优势的酒精护理联动 (SLAC) 多地点试点试验

• 批准号: 10312566
• 负责人: Michael Anthony Cucciare
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10312566
• 关键词: Academy; Acute; Address; Age; Alcohol abuse; Alcohol consumption; Alcohols; Area; Behavioral; Caring; Chronic; Clinical; Clinical effectiveness; Counseling; Decision Making; Disease; Effectiveness; Enrollment; Ensure; Evidence based intervention; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; High Prevalence; Hybrids; Improve Access; Intervention; Interview; Knowledge; Lead; Letters; Link; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Methodology; Monitor; Motivation; Outcome; Patients; Population; Post-Traumatic Stress Disorders; Primary Health Care; Provider; Psychologist; Randomized Controlled Trials; Recommendation; Reporting; Risk; Role; Services; Site; Social Workers; Substance Use Disorder; Suicide prevention; Testing; Time; Uncertainty; Veterans; adverse outcome; alcohol screening; alcohol use disorder; barrier to care; base; care providers; care seeking; clinical care; comorbidity; cost outcomes; design; diagnostic criteria; drinking; eHealth; evidence base; follow-up; hazardous drinking; high risk; improved; improved outcome; information gathering; innovation; interest; medical specialties; medication-assisted treatment; meetings; member; military veteran; novel; novel strategies; operation; pilot test; pilot trial; primary care setting; satisfaction; screening; skills; substance use; telephone delivery

Project Summary/Abstract Background: Relatively few Veterans screening positive for hazardous drinking in primary care (PC) receive alcohol care in the year following their alcohol screening. This suggests that existing VHA options for linking Veterans in need of alcohol care, including those with comorbid hazardous drinking and PTSD and/or depression (A-MH), are not effective. To that end, we have identified and propose to pilot test a promising evidence-based intervention, Strengths-based Linkage to Alcohol Care (SLAC). SLAC has the potential to increase linkage to alcohol care, as well as to improve drinking and mental health outcomes, among Veterans with A-MH in PC. Significance: Existing VHA options such as VHA-recommended brief alcohol counseling do not improve linkage to alcohol care, suggesting a critical need for more intensive but practical efforts to link Veterans with A-MH to care. This proposal directly addresses HSR&D priorities in the areas of Access to Care, Mental Health (PTSD), and Primary Care by testing a novel approach (SLAC) to linking Veterans with A-MH to VA and non- VA alcohol care and to improve their drinking and mental health outcomes. Innovation and Impact: The proposed project is highly innovative because it offers a solution to the critical gap in VHA care in which most Veterans in need of alcohol care do not receive it. It tests a strategy to increase linkage to alcohol care that is both intensive enough to produce change, yet feasible to use in busy clinical settings with too-high demand on too-few staff members. A highly innovative feature of SLAC is that it teaches PC providers how to link Veterans with A-MH to alcohol care, which may help normalize conversations about patients’ alcohol use and their care options in PC as part of the provider role. PC providers’ lack of knowledge on how to treat hazardous drinking is a substantial obstacle to Veterans receiving alcohol care. Additional unique and innovative features of SLAC are that it uses patients’ self-identified strengths, abilities, and skills to help them link to an alcohol care option. Specific Aims: Our two aims are (Aim 1): To adapt SLAC for use among Veterans with A-MH and for delivery by telephone in the VHA PC setting. We will conduct qualitative interviews with Veterans, PC staff, and our VACO operational partners to ensure that the content and format of SLAC are adapted so they are relevant and acceptable to these stakeholders. (Aim 2): To determine (a) the feasibility of conducting a larger scale randomized controlled trial (RCT) to test SLAC’s effectiveness and (b) SLAC’s acceptability among Veterans with A-MH in PC, and to explore (c) the efficacy of SLAC in this Veteran population. To achieve Aim 2, we will conduct a multi-site pilot RCT of SLAC at two VA medical facilities (Little Rock, AR and Palo Alto, CA). To achieve Aims 2a-b, we will measure the feasibility (e.g., rates of enrollment and follow-up, fidelity to the SLAC intervention) of conducting a subsequent larger RCT (to test SLAC’s effectiveness) and SLAC’s acceptability (SLAC completion rates, satisfaction with SLAC) among Veterans. To achieve Aim 2c, we will explore the efficacy of SLAC to improve Veterans’ linkage to and utilization of alcohol care, and their alcohol and mental health outcomes, at 3-month follow-up. Methodology: We will use (Aim 1) qualitative interviews to adapt SLAC for Veterans with A-MH and for PC, and (Aim 2) conduct a multi-site, pilot RCT. Debriefing interviews with Veterans will follow the pilot RCT. Next Steps/Implementation: Should our findings justify a subsequent project, we plan to propose a fully powered, multi-site study, using a Hybrid design, to test SLAC’s clinical effectiveness when delivered in VHA PC while observing and gathering information on the implementation potential of SLAC in this setting. Our operations partners are committed to implementing SLAC nationally should it be found to be effective.

项目总结/摘要 背景：在初级保健（PC）中对危险饮酒筛查呈阳性的退伍军人相对较少， 在酒精筛查后的一年内进行酒精护理。这表明，现有的VHA连接选项 需要酒精护理的退伍军人，包括危险饮酒和创伤后应激障碍共病者和/或 抑郁症（A-MH），没有效果。为此，我们确定了一个有希望的方案，并建议进行试点。 循证干预，基于优势的联系，酒精护理（SLAC）。SLAC有潜力 增加与酒精护理的联系，以及改善退伍军人的饮酒和心理健康结果 在PC中使用A-MH。 意义：现有的VHA选择，如VHA推荐的简短酒精咨询，并没有改善 与酒精护理的联系，这表明迫切需要更深入但实际的努力，将退伍军人与 A-MH照顾。该提案直接涉及HSR&D在获得护理、心理健康和健康方面的优先事项。 （PTSD）和初级保健，通过测试一种新的方法（SLAC）将退伍军人与A-MH联系起来， VA酒精护理和改善他们的饮酒和心理健康结果。 创新和影响：拟议项目具有高度创新性，因为它为关键问题提供了解决方案。 VHA护理的差距，其中大多数需要酒精护理的退伍军人没有得到它。它测试了一种策略，以增加 与酒精护理的联系，既足以产生变化，又可用于忙碌的临床 工作人员太少，要求太高。SLAC的一个高度创新的特点是， PC提供商如何将患有A-MH的退伍军人与酒精护理联系起来，这可能有助于规范关于 患者的酒精使用和他们的护理选择在PC作为提供者角色的一部分。PC供应商缺乏知识 如何对待危险饮酒是退伍军人接受酒精护理的一个重大障碍。额外 SLAC的独特和创新特点是，它利用患者自我确定的优势，能力和技能， 帮助他们联系到酒精护理选项。 具体目标：我们的两个目标是（目标1）：调整SLAC用于A-MH退伍军人和交付 通过电话在VHA PC设置。我们将对退伍军人、PC工作人员和我们的 VACO业务合作伙伴确保SLAC的内容和格式经过调整，使其具有相关性 并为这些利益相关者所接受。(Aim 2）：确定（a）开展更大规模的 随机对照试验（RCT），以测试SLAC的有效性和（B）SLAC在退伍军人中的可接受性 在PC中使用A-MH，并探索（c）SLAC在该退伍军人人群中的疗效。为了实现目标2，我们将 在两个VA医疗机构（阿肯色州小石城和加利福尼亚州帕洛阿尔托）进行SLAC的多中心试点RCT。到 实现目标2a-b，我们将衡量可行性（例如，入组率和随访率，对SLAC的忠诚度 干预）进行后续更大规模的随机对照试验（以测试SLAC的有效性）和SLAC的可接受性 (SLAC完成率，对SLAC的满意度）。为了实现目标2c，我们将探讨 SLAC对改善退伍军人与酒精护理联系和利用以及酒精和精神状况的有效性 3个月随访时的健康结局。 方法：我们将使用（目标1）定性访谈，以适应SLAC的退伍军人与A-MH和PC， 和（目标2）进行多中心试验性随机对照试验。与退伍军人的汇报采访将遵循试点RCT。 下一步/实施：如果我们的发现证明后续项目是合理的，我们计划提出一个全面的 采用混合设计的动力、多中心研究，以测试SLAC在VHA中交付时的临床有效性 同时观察和收集关于SLAC在此背景下的实施潜力的信息。我们 业务伙伴承诺，如果发现有效，将在国家一级实施SLAC。