Computer-facilitated Screening and Brief Intervention in pediatric primary care to reduce underage drinking: a large multi-site randomized trial

儿科初级保健中计算机辅助筛查和简短干预以减少未成年人饮酒：一项大型多中心随机试验

• 批准号: 10379996
• 负责人: Sion Kim Harris
• 金额: $ 65.08万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-10 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379996
• 关键词: 17 year old; Academy; Address; Adolescent; Adult; Advisory Committees; Advocacy; Age; Alcohol consumption; Alcohols; American; Area; Automobile Driving; Boston; Caring; Cause of Death; Child; Childhood; Cluster randomized trial; Computers; Contracts; Counseling; Drunk driving; Early Intervention; Early identification; Education; Educational process of instructing; Enrollment; Family; Feedback; Frequencies; Gender; Goals; Health; Healthcare; Impairment; Intervention; Mediator of activation protein; Medical; Motivation; National Institute on Alcohol Abuse and Alcoholism; New England; Parents; Patients; Pediatric Research; Pediatrics; Phase; Pilot Projects; Play; Population; Practice based research; Preventive service; Primary Health Care; Protocols documentation; Quasi-experiment; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Risk; Role; Safety; Sampling; Science; Screening Result; Self Administration; Self Efficacy; Severities; Site; Surveys; System; Testing; Time; Training; Transportation; Trust; Vehicle crash; Visit; Work; Youth; adolescent patient; age group; alcohol misuse; alcohol screening; alcohol screening and brief intervention; alcohol use disorder; base; binge drinking; brief intervention; design; drinking; driving safety; effectiveness testing; follow-up; impaired driving performance; improved; individualized feedback; interest; intervention effect; member; motivational enhancement therapy; patient screening; pediatrician; pilot test; practice setting; practice-based research network; primary outcome; psychoeducational; randomized controlled design; randomized trial; recruit; response; screening; screening and brief intervention; sobriety; societal costs; substance use; success; treatment as usual; underage drinking reduction; young adult

PROJECT SUMMARY/ABSTRACT Alcohol use disorders frequently have a pediatric origin. Pediatric primary care offices, where the majority of adolescents receive health care, are a promising venue for early identification and intervention through universal screening and brief counseling. However, while the U.S. Preventive Services Task Force recommends primary care-based alcohol screening and brief intervention for adults, it found insufficient evidence to recommend it for adolescents. The goal of the proposed study is to address this evidence gap by testing the effectiveness of a promising computer-facilitated Screening and Brief Intervention (cSBI) system for delivery by pediatric primary care clinicians to adolescents at well-visits. This cluster-randomized controlled trial will be conducted in the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) national primary care practice-based research network. PROS has demonstrated success in >30 years of practice-based research, with >600 practices participating in recent studies. Drawing on more than 15 years of our prior research on adolescent alcohol screening and brief counseling in primary care offices, the cSBI system was developed to provide a time-efficient and feasible way for pediatric practices to improve both the frequency and quality of alcohol screening and counseling. cSBI includes: 1) computer self-administered screening that adolescents complete prior to seeing their clinician, 2) computer-delivered personalized feedback to the adolescent, 3) 10 interactive psychoeducational pages for the adolescent on substance use health risks, 4) a Clinician Report Form with screen results and prompts that clinicians use to provide motivational interviewing-based individualized counseling, and 5) clinician training materials and protocol. In our New England-based pilot study, we found that, compared to usual care (UC), the cSBI approach: 1) increased patient receipt of alcohol-related counseling during well-visits; 2) improved patients' ratings of the quality of their clinician encounter; and 3) among those who reported past-year use at baseline (n=192), was associated with a 34% lower risk of a heavy episodic drinking episode during 12 months follow-up. cSBI also reduced risk of riding with an impaired driver, a major safety risk associated with alcohol, by 42% among those with prior riding risk. A larger RCT of this approach, which employs an adequately-powered sample and tests generalizability of effects beyond New England, is needed. We propose to randomize >30 pediatric primary care clinicians in 10 practices nationwide to deliver UC or cSBI (1:1) to their eligible and assenting 14- to 17- year-old patients arriving for well-visits. Our aims are to test cSBI's effect on heavy episodic drinking, and on riding with an impaired driver/driving while impaired, during 12 months follow-up among 1,268 adolescents screen-identified as at-risk. If effective, cSBI dissemination could leverage existing AAP platforms including education, teaching, and advocacy, to its 67,000 pediatrician members, greatly increasing the potential for population-level impact of alcohol screening and brief intervention for U.S. adolescents.

项目摘要/摘要 酒精使用障碍经常具有儿科起源。小儿初级保健办公室，大多数 青少年获得医疗保健，是通过 普遍筛查和简短的咨询。但是，尽管美国预防服务工作队 建议基于初级保健的酒精筛查和成人的简短干预，发现不足 向青少年推荐它的证据。拟议的研究的目的是解决这一证据差距 测试有前途的计算机采用筛选和简短干预（CSBI）系统的有效性 小儿初级保健临床医生将其交付给青少年。该群集随机控制 试验将在美国儿科学会（AAP）的儿科研究中进行。 （优点）国家初级保健实践研究网络。专业人士在> 30中取得了成功 多年的基于实践的研究，> 600个实践参与了最近的研究。利用超过15 多年来，我们先前关于青少年酒精筛查和初级保健办公室的简短咨询的研究， 开发CSBI系统旨在为小儿实践提供时间效率和可行的方法来改善两者 酒精筛查和咨询的频率和质量。 CSBI包括：1）计算机自我管理 筛选青少年在见他们的临床医生之前完成的，2）计算机交付的个性化 青少年的反馈，3）10个互动性心理教育页面，用于青少年的物质使用 健康风险，4）临床医生报告表格，并提示临床医生用来提供的临床医生 基于访谈的动机个性化咨询，以及5）临床医生培训材料和协议。在 我们的新英格兰试点研究，我们发现，与通常的护理（UC）相比，CSBI方法：1） 在待遇期间，患者收到与酒精有关的咨询的增加； 2）提高患者的评级 临床医生相遇的质量； 3）在基线上报告过去一年使用（n = 192）的人中， 在12个月的随访中，大量发作性饮酒发作的风险降低了34％。 CSBI也是如此 与酒精相关的主要安全风险降低了骑行的风险，其中的主要安全风险降低了42％ 具有先前的骑行风险。这种方法的较大RCT，该方法采用了充分动力的样本和测试 需要新英格兰以外的效果的普遍性。我们建议随机化> 30个小儿初级 全国10个实践中的护理临床医生将UC或CSBI（1：1）交付给其合格并同意14至17-- 年龄的患者到达待遇。我们的目的是测试CSBI对大量情节饮酒的影响，并在 在受损时与驾驶员/驾驶受损的骑行，在12个月的后续行动中，在1,268名青少年中 屏幕鉴定为处于危险中。如果有效，CSBI的传播可以利用现有的AAP平台 对67,000名儿科成员的教育，教学和倡导，大大提高了潜力 酒精筛查和对美国青少年的简短干预的人群级别的影响。