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

近2200万12岁及以上的美国人(8.1%)需要治疗药物使用障碍(SUD)。虽然只有 10%-11%的人需要接受sud治疗，估计有三分之二的人接受初级保健或紧急治疗。 护理人员每6个月一次。初级保健提供者处于独特的地位，可以进行筛查、短暂干预、 和转诊至治疗(SBIRT)。在第一阶段合同资金的支持下，Pro-Change开发并试行了一款移动- 提供物质使用干预(SURI)旨在通过提供全民服务来减少初级保健SBIRT的障碍 在家中或在诊所对患者进行SUD风险筛查和反馈。对于有风险的患者，该计划还提供：1) 基于跨理论行为改变模型(TTM)的简短干预，以促进通过 戒除最有问题的药物和寻求治疗(如有适应症)的阶段；以及2)30天 与阶段匹配的短信和四个针对关键主题的在线活动(例如，管理渴望)。对于提供商而言， 干预原型包括一个临床仪表板，该仪表板汇总了患者的SUD风险评分和 更改数据，并提供与阶段匹配的脚本来指导简短的面对面干预会议。节目进行得很好- 在一次小型试飞中收到。此Fast-Track项目第一阶段的目标是规划附加的Suri功能和 有效集成到临床实践中所需的功能，包括电子健康记录(EHR)集成 并确定我们的方法在一个具有联邦资格的卫生中心的诊所范围内实施的可行性 地点。如果确定了可行性，干预措施将在1300名患者中进行整群随机试验 被随机分配到治疗或日常护理的20名FQHC招募。结果将包括使用患者的天数 最有问题的药物和其他衡量物质使用和幸福感的指标在9个月的随访中。

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.