Harnessing telemedicine to improve alcohol use disorder outcomes in primary care patients

项目摘要/摘要 酒精使用障碍(AUD)很常见，会导致广泛的功能障碍、发病率 和死亡率。循证心理社会治疗，特别是认知行为治疗(CBT) 和激励性访谈(MI)，是有效的；但是，只有不到10%的AUD患者接受治疗。 以前的努力侧重于初级保健中的筛查、短暂干预和转诊治疗(SBIRT)。 然而，由于障碍(例如，治疗可获得性差、耻辱)，转诊未能增加治疗使用率 专科成瘾诊所)导致转诊患者不寻求治疗。此外，患者通常是 不寻求治疗的患者(即没有到澳大利亚大学附属医院就诊的患者)的饮酒目标可能有所不同。因此，新的 在大型、分散的人群中参与并提供有效治疗的护理模式 AUD患者的人口是迫切需要的。 远程医疗，特别是在分开的提供者和患者之间举行同步视频会议 地点，通过在家中为患者提供护理并减少 在特殊护理环境中接受治疗的耻辱。远程医疗在许多情况下都是有效的，但 到目前为止，还没有针对澳门氏症的疗效试验。尽管有限的远程医疗基础设施一直是 过去，新冠肺炎大流行证明，它可以迅速实施和广泛使用。有一个 迫切需要确定远程医疗提供的AUD治疗是否有效地通知传播。 因此，本研究的目的是评估远程医疗传递的MI-CBT治疗干预对 AUD(MI-CBT TeleTx)与增强型日常护理(EUC)在AUD治疗利用率和酒精使用方面的比较。 密歇根州东南部两个大型医疗系统的AUD初级保健患者将被招募并 随机到MI-CBT TeleTx或EUC。具体目标是： 目标1：确定提供TeleTx干预选项(n=150)与 EUC(n=150)对初诊AUD患者的AUD治疗利用情况。目标2：确定 将TeleTx干预与EUC在饮酒天数和重度饮酒天数百分比上进行比较， 6个月、12个月的随访期。目的3：确定TeleTx干预对酒精相关疾病的影响 后果和功能(例如，生活质量、精神健康)以及酒精风险的缓和作用 级别降低。此外，一个探索性目标是确定干预效果的关键中介因素。 治疗使用(通过改善治疗可及性和减少耻辱)和酒精使用(通过 治疗使用)。影响：这项研究的发现将对公共卫生产生重大影响，作为一种新颖和 可扩展的方法，以解决巨大的AUD治疗缺口。此外，这项工作将是第一次大规模的疗效试验 远程医疗和UD干预，并测试一种旨在吸引非治疗寻求的新护理模式 并为传统专科护理环境之外的患者提供有效的AUD治疗。

Project Summary/Abstract Alcohol use disorder (AUD) is common and contributes to extensive functional impairments, morbidity and mortality. Evidence-based psychosocial treatments, in particular Cognitive Behavioral Therapies (CBT) and Motivational Interviewing (MI), are effective; but, fewer than 10% of people with AUD receive treatment. Prior efforts have focused on screening, brief intervention and referral to treatment (SBIRT) in primary care. However, referral has failed to increase treatment use due to barriers (e.g., poor treatment accessibility, stigma of specialty addiction clinics) causing referred patients not to seek care. In addition, patients who are typically non-treatment seeking (i.e., patients not presenting for AUD care) may vary in their drinking goals. Thus, new models of care to engage and deliver effective treatments across the spectrum of the large, dispersed population of AUD patients are critically needed. Telemedicine, specifically synchronous videoconferencing between providers and patients in separate locations, can potentially help increase treatment utilization by delivering care to patients at home and reducing stigma of attending treatment in specialty care settings. Telemedicine is effective for many conditions, but there have been no efficacy trials to date for AUD. Although limited telemedicine infrastructure has been a barrier in the past, the COVID-19 pandemic has proven that it can be rapidly implemented and widely used. There is an urgent need to determine if telemedicine delivered AUD treatment is efficacious to inform dissemination. Therefore, the objective of this study is to evaluate a telemedicine-delivered MI-CBT treatment intervention for AUD (MI-CBT TeleTx) compared to Enhanced Usual Care (EUC) on AUD treatment utilization and alcohol use. Primary care patients with AUD in two large healthcare systems in southeast Michigan will be recruited and randomized to either MI-CBT TeleTx or EUC. Specific Aims are: Aim 1: Determine the impact of providing the option of the TeleTx intervention (n=150) compared to EUC (n=150) in primary care patients with AUD on AUD treatment utilization. Aim 2: Determine the efficacy of the TeleTx intervention compared to EUC on percent drinking days and percent heavy drinking days across 3-, 6-, and 12-month follow-ups. Aim 3: Determine the effect of the TeleTx intervention on alcohol-related consequences and functioning (e.g., quality of life, mental health) and the moderating effect of alcohol risk level reductions. In addition, an exploratory aim is to determine key mediators of the effect of intervention on treatment use (through improved treatment accessibility and reduced stigma) and on alcohol use (through treatment use). Impact: The findings from this study will have a significant public health impact as a novel and scalable approach to address the large AUD treatment gap. Further, the work will be the first large efficacy trial of a telemedicine AUD intervention and test a new model of care designed to engage non-treatment seeking patients and deliver effective AUD treatment to patients outside of traditional specialty care settings.