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.

项目概要/摘要 酒精使用障碍通常起源于儿科。儿科初级保健办公室，其中大多数 青少年接受医疗保健，是通过以下方式进行早期识别和干预的一个有前途的场所 普遍筛查和简短咨询。然而，虽然美国预防服务工作组 建议对成年人进行初级保健酒精筛查和短暂干预，但发现不足 向青少年推荐它的证据。拟议研究的目标是通过以下方式解决这一证据差距： 测试有前景的计算机辅助筛查和简短干预 (cSBI) 系统的有效性 由儿科初级保健临床医生在青少年就诊时为他们提供服务。这种整群随机对照 试验将在美国儿科学会 (AAP) 儿科研究办公室进行 (PROS) 国家初级保健实践研究网络。 PROS 已在超过 30 个领域取得成功 多年基于实践的研究，超过 600 个实践参与了最近的研究。借鉴超过15个 我们之前对青少年酒精筛查和初级保健办公室的简短咨询进行了多年的研究， cSBI 系统的开发旨在为儿科实践提供一种省时且可行的方法，以改善儿科实践 酒精筛查和咨询的频率和质量。 cSBI 包括： 1) 计算机自我管理 青少年在看临床医生之前完成的筛查，2) 计算机提供的个性化服务 向青少年提供反馈，3) 10 个针对青少年的关于药物滥用的互动心理教育页面 健康风险，4) 临床医生报告表，其中包含临床医生用于提供的筛查结果和提示 基于动机访谈的个性化咨询，以及 5) 临床医生培训材料和协议。在 我们在新英格兰开展的试点研究发现，与常规护理 (UC) 相比，cSBI 方法：1) 在健康访问期间增加患者接受酒精相关咨询的机会； 2）提高患者对治疗的评价 他们与临床医生接触的质量； 3) 在那些报告过去一年基线使用情况的人中 (n=192)， 在 12 个月的随访期间，出现严重间歇性饮酒的风险降低了 34%。 cSBI 还 与酒精相关的主要安全风险——与不清醒的驾驶员一起骑行的风险降低了 42% 有事先骑行风险。这种方法的更大的随机对照试验，采用了足够有力的样本和测试 需要将影响推广到新英格兰以外的地区。我们建议将 >30 名儿科初级儿童随机分组 全国 10 个诊所的护理临床医生向符合资格并同意的 14 至 17 岁儿童提供 UC 或 cSBI (1:1) 前来就诊的四岁患者。我们的目标是测试 cSBI 对重度间歇性饮酒的影响，以及对 对 1,268 名青少年进行为期 12 个月的跟踪调查，发现与不清醒的驾驶员一起骑行/在不清醒的情况下驾驶 屏幕识别为有风险。如果有效，cSBI 传播可以利用现有的 AAP 平台，包括 向其 67,000 名儿科医生成员提供教育、教学和宣传，大大提高了儿科医生的潜力 酒精筛查和短暂干预对美国青少年的人口影响。