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

项目总结/文摘

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.