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%）需要治疗物质使用障碍（SUD）。而只有 10%-11%需要治疗SUD的人接受了治疗，估计三分之二的人接受了初级保健或紧急治疗。 每6个月护理一次。初级保健提供者处于一个独特的位置，进行筛查，简短的干预， 转诊治疗（SBIRT）。在第一阶段合同资金的支持下，Pro-Change开发并试点测试了一个移动的- 提供物质使用干预（SURI），旨在通过提供普遍的 在家中或诊所对患者进行SUD风险筛查和反馈。对于有风险的患者，该计划还提供：1） 基于行为改变的跨理论模型（TTM）的简短干预，以促进通过 改变的阶段，以放弃他们最有问题的药物，并寻求治疗，如果指示;和2）30天的 阶段匹配的文本消息和四个在线活动，涉及关键主题（例如，管理渴望）。对于供应商来说， 干预原型包括一个临床仪表板，它总结了患者的SUD风险评分和 更改数据，并提供阶段匹配的脚本，以指导简短的面对面干预会话。节目很好- 在一个小的试点测试中获得。该快速通道项目第一阶段的目标是规划附加SURI功能， 有效整合到临床实践中所需的功能，包括电子健康记录（EHR）整合 并在一个联邦合格的卫生中心建立我们的方法在诊所范围内实施的可行性 绝佳的价钱如果可行性得到证实，将在1300名患者中进行随机分组试验 由随机分配到治疗或常规护理的20名CIMHC招募。结果将包括患者使用的天数 在9个月随访时，最有问题的药物和其他物质使用和福祉指标。

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.