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

项目摘要/摘要 背景：在初级保健(PC)中接受危险饮酒筛查阳性的退伍军人相对较少 在酒精筛查后的第二年进行酒精护理。这表明现有的用于链接的VHA选项 需要酒精护理的退伍军人，包括那些同时患有危险饮酒和创伤后应激障碍和/或 抑郁症(A-MH)，都是无效的。为此，我们已经确定并提议试运行一种有前景的 循证干预，基于强项的酒精护理联系(SLAC)。SLAC有可能 在退伍军人中增加与酒精护理的联系，以及改善饮酒和精神健康结果 在PC中使用A-MH。 意义：现有的VHA选项，如VHA推荐的短暂酒精咨询并没有改善 与酒精护理的联系，表明迫切需要更密集但实际的努力，将退伍军人与 A-MH去关心。该提案直接涉及获得护理、精神健康等领域的高铁和研发优先事项 (PTSD)和初级保健，通过测试一种新的方法(SLAC)将患有A-MH的退伍军人与VA和非 退伍军人协会提供酒精护理，并改善他们的饮酒和心理健康状况。 创新和影响：拟议的项目具有很高的创新性，因为它为关键的 VHA护理方面的差距，在这方面，大多数需要酒精护理的退伍军人得不到护理。它测试了一种战略，以增加 与酒精护理的联系既足够密集，可以产生变化，又可以在繁忙的临床中使用 环境要求太高，工作人员太少。SLAC的一个高度创新的特点是它教会了 PC提供商如何将退伍军人与A-MH与酒精护理联系起来，这可能有助于正常化关于 作为提供者角色的一部分，患者在PC中的酒精使用和他们的护理选项。个人电脑供应商的知识匮乏 如何治疗危险饮酒是退伍军人接受酒精护理的一个重大障碍。其他内容 SLAC的独特和创新特征是它利用患者自我识别的优势、能力和技能来 帮助他们链接到酒精护理选项。 具体目标：我们的两个目标是(目标1)：使SLAC适用于患有A-MH的退伍军人并用于分娩 在VHA PC设置中通过电话。我们将对退伍军人、PC工作人员和我们的 VACO运营合作伙伴，以确保SLAC的内容和格式得到调整，使其具有相关性 并为这些利益相关者所接受。(目标2)：确定(A)进行更大规模活动的可行性 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 并探讨(C)SLAC在这一老兵人群中的疗效。为了达到目标2，我们将 在退伍军人事务部的两个医疗机构(阿肯色州小石城和加利福尼亚州帕洛阿尔托)进行SLAC的多地点RCT试点。至 为了达到2a-b的目标，我们将衡量可行性(例如，参保率和后续行动、对SLAC的忠诚度 干预)进行随后更大的随机对照试验(以测试SLAC的有效性)和SLAC的可接受性 (SLAC完成率、SLAC满意度)。为达致目标2c，我们会探讨 SLAC对改善退伍军人对酒精护理的联系和利用及其酒精和心理的效果 健康结果，在3个月的随访中。 方法：我们将使用(目标1)定性访谈来使SLAC适用于患有A-MH和PC的退伍军人， 和(目标2)开展多地点试点区域合作研究。在试点RCT之后，将对退伍军人进行汇报采访。 下一步/实施：如果我们的调查结果证明后续项目是合理的，我们计划提出一个完整的 采用混合设计的有动力的多点研究，以测试在VHA中提供SLAC的临床有效性 个人计算机，同时观察和收集关于在这种情况下SLAC的实施潜力的信息。我们的 如果发现SLAC有效，业务伙伴将致力于在全国范围内实施SLAC。

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.