Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes

项目摘要/摘要 新冠肺炎的流行使酒精中毒患者的虚拟治疗发生了戏剧性的转变 有问题。这种转变引发了人们对获得虚拟治疗的潜在差距的质疑， 鉴于现有的“数字鸿沟”，老年患者、有色人种患者和低收入患者 社会经济地位可能较少使用宽带、计算机和其他数字设备 设备。患者还可能面临保密问题、缺乏私人空间等障碍 参加虚拟会议，以及对虚拟治疗体验的不满。在… 同时，虚拟治疗的特点，如便捷性和免费性 运输及其成本可能会增加获得和使用的机会，特别是对代表性不足的人 患者群体。这项拟议的研究调查了在虚拟酒精治疗方面的差异 有酒精问题的患者，定义为过度饮酒和酒精使用障碍 (澳元)在一个大型、多样化的医疗保健提供系统中，能够快速转向虚拟 在大流行期间提供酒精治疗。使用丰富的电子健康记录和声明 数据，我们检查了酒精问题识别的变化，以及几种治疗措施 (简短的干预、药物治疗，以及专业的启动、参与和保留 成瘾治疗)比较访问类型(虚拟/非虚拟、电话、视频)与前 新冠肺炎(2019年3月12日)至新冠肺炎起效后(2020年3月12日)时间段。使用一个 大样本205,293名有酒精问题的患者，我们将专门探索差异 根据种族/民族、性别、年龄和社会经济地位，检查不同的严重程度 酗酒的问题。我们探讨了在这个动荡时期的差额保险损失，以及 医疗服务利用率(例如急诊科、初级保健、精神科、电子邮件安全 消息)。我们严谨的分析计划包含中断的时间 系列(ITS)和广义估计方程(GEE)模型，以解决研究目标。早些时候 有证据表明，在新冠肺炎大流行期间，酒精问题有所增加， 虚拟治疗很可能会在大流行后继续作为一种重要的治疗方式。发现 对病人护理有重要影响，特别是对提高病人护理质量 弱势群体。此外，研究队列将是未来研究的宝贵资源 关于虚拟酒精治疗及其对患者预后的长期影响。

Project Summary/Abstract The COVID-19 pandemic has led to a dramatic shift to virtual treatment for patients with alcohol problems. This shift raises questions about potential disparities in access to virtual treatment, given the existing ‘digital divide,’ where older patients, patients of color, and patients of lower socio-economic status may have less access to broadband, computers, and other digital devices. Patients may also face barriers such as confidentiality concerns, lack of private space for participating in virtual sessions, and dissatisfaction with the virtual therapeutic experience. At the same time, features of virtual treatment, such as convenience and elimination of transportation and its costs, may increase access and use, particularly for underrepresented patient populations. The proposed study examines disparities in virtual alcohol treatment among patients with alcohol problems, defined as both excessive alcohol use and alcohol use disorder (AUD) in a large, diverse, health care delivery system that was able to quickly pivot to virtual alcohol treatment delivery during the pandemic. Using rich electronic health record and claims data, we examine changes in alcohol problem identification, and in several treatment measures (brief intervention, pharmacotherapy, and initiation, engagement, and retention in specialty addiction treatment) comparing visit types (virtual/non-virtual, telephone, video) from a pre- COVID-19 (3/2019-12/2019) to post-COVID-19 onset (3/2020-12/2020) time period. With a large sample of 205,293 patients with alcohol problems, we will specifically explore disparities by race/ethnicity, gender, age, and socioeconomic status, and examine different severity levels of alcohol problems. We explore differential insurance loss during this turbulent time, as well as health services utilization (e.g. emergency department, primary care, psychiatry, email secure messages) by the study population. Our rigorous analytic plan incorporates interrupted time series (ITS), and generalized estimating equation (GEE) models to address study aims. Early evidence suggests alcohol problems have increased during the COVID-19 pandemic, and virtual treatment will likely continue post-pandemic as an important treatment modality. Findings have important implications for patient care, particularly for improving quality of care for vulnerable populations. Further, the study cohort will be a valuable resource for future research on virtual alcohol treatment, and its long-term impact on patient outcomes.