Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Implementation and Cluster-Randomized Trial

初级保健中药物滥用障碍的阶段性移动干预：实施和整群随机试验

基本信息

批准号：
10405075
负责人：
Kerry Evers
金额：
$ 5.89万
依托单位：
PRO-CHANGE BEHAVIOR SYSTEMS, INC.
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-15 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10405075
关键词：
Abstinence Address Adoption Age Alcohols American Caring Client satisfaction Clinic Clinical Cluster randomized trial Contracts Data Day Care Development Electronic Health Record Federally Qualified Health Center Feedback Funding Gender Goals Hair Health Home Individual Intervention Interview Location Measures Modeling National Institute of Drug Abuse Outcome Participant Patient Care Patient Recruitments Patient Self-Report Patient-Focused Outcomes Patients Personal Satisfaction Persons Pharmaceutical Preparations Phase Positioning Attribute Primary Health Care Procedures Provider Randomized Recommendation Research Review Literature Risk Services Site Small Business Innovation Research Grant Smoking Substance Use Disorder System Technology Testing Text Messaging Translating Treatment Efficacy base behavior change brief intervention care providers clinical practice comparative efficacy craving dashboard design disorder risk drug testing feasibility testing follow-up high risk implementation intervention implementation science inclusion criteria intervention effect intervention program medical specialties mobile computing pilot test primary outcome programs prototype randomized trial response screening screening and brief intervention screening, brief intervention, referral, and treatment secondary outcome substance use therapy design therapy development tool treatment as usual uptake urgent care usability

项目摘要

Nearly 22 million Americans age 12 and older (8.1%) need treatment for a substance use disorder (SUD). While only 10%-11% of individuals requiring treatment for a SUD receive it, an estimated two-thirds see a primary care or urgent care provider every 6 months. Primary care providers are in a unique position to perform Screening, Brief Intervention, and Referral to Treatment (SBIRT). With Phase I contract funding, Pro-Change developed and piloted-tested a mobile- delivered Substance Use Intervention (SURI) designed to reduce barriers to SBIRT in primary care by delivering universal screening and feedback on SUD risk to patients at home or in the clinic. For patients at risk, the program also delivers: 1) a brief intervention based on the Transtheoretical Model of Behavior Change (TTM) to facilitate progress through the stages of change for quitting their most problematic drug, and for seeking treatment if indicated; and 2) 30 days of stage-matched text messages and four online activities addressing key topics (e.g., managing cravings). For providers, the intervention prototype includes a Clinical Dashboard that summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide a brief in-person intervention session. The program was well- received in a small pilot test. The goals in Phase I of this Fast-Track project are to program additional SURI features and functions–including Electronic Health Record (EHR) integration–required for effective integration into clinical practice and to establish the feasibility of our approach in a clinic-wide implementation in one federally qualified health center site. If feasibility is established the intervention will be tested in a cluster-randomized trial among 1300 patients recruited by 20 FQHCs randomly assigned to treatment or usual care. Outcomes will include days of use of the patient’s most problematic drug and other measures of substance use and well-being at 9 months follow-up.

近2200万美国人12岁及以上（8.1％）需要治疗药物使用障碍（SUD）。虽然只有 10％-11％需要用于SUD治疗的个人接受了该水平的接受每6个月的护理提供商。初级保健提供者处于执行筛查，简短干预，并转介治疗（SBIRT）。随着第一阶段的合同资金，Pro-Crangange开发并进行了试点测试的手机 - 旨在通过传递通用的供应减少初级保健中SBIRT的障碍的交付药物使用干预措施（SURI）筛查和反馈对家里或诊所患者的SUD风险。对于有风险的患者，该计划还提供：1）基于行为改变（TTM）的跨理论模型的简短干预，以促进通过退出最有问题的药物的变化阶段，并寻求治疗； 2）30天阶段匹配的短信和四个在线活动，涉及关键主题（例如，渴望管理）。对于提供者，干预原型包括一个临床仪表板，总结了患者的SUD风险评分和阶段更改数据，并提供阶段匹配的脚本来指导简短的面对面干预会话。该程序很好在小型试点测试中收到。这个快速轨道项目的第一阶段目标是编程其他Suri功能和功能 - 包括电子健康记录（EHR）集成的功能 - 需要有效整合到临床实践中并确定我们在一个联邦资格卫生中心的诊所实施中的可行性地点。如果确定可行性，则将在1300名患者的聚类随机试验中测试干预措施由20个FQHC招募，这些FQHC随机分配到治疗或通常的护理中。结果将包括患者的日子大多数有问题的药物以及在9个月后续使用物质使用和福祉的其他措施。