HOW MUCH DOES SHE REALLY DRINK--HMO INTERVENTION

她实际喝了多少——HMO 干预

• 批准号: 6051728
• 负责人: GABRIEL J. ESCOBAR
• 金额: $ 30.28万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2004-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6051728
• 关键词: alcoholic beverage consumption; alcoholism /alcohol abuse education; alcoholism /alcohol abuse information system; behavioral /social science research tag; clinical research; clinical trials; combination therapy; counseling; ethanol; female; fetal alcohol syndrome; health behavior; health care service evaluation; health services research tag; hospital utilization; human pregnant subject; human therapy evaluation; longitudinal human study; low birth weight infant human; managed care; outcomes research; perinatal; pregnancy disorder; premature infant human; women's health

Alcohol abuse during pregnancy is a serious problem. Research suggests that 1) abstinence is the optimum strategy, but any decrease in alcohol consumption during pregnancy is beneficial; 2) drinkers underestimate their ethanol consumption; 3) supportive counseling is better than impersonal or purely medical approaches; and 4) in the context of a supportive environment, desire for a healthy baby is a powerful motivator. We propose to test a simple intervention in a mature managed care organization. The Kaiser Permanente Medical Care Program has implemented a substance abuse harm reduction program known as Early Start in 15 obstetrics clinics in California. We propose to enhance Early Start by helping women recognize how much alcohol they consume. We will use sample vessels, photographs of similar containers, and a simple software application that permits a counselor to show a pregnant woman what the Quantity and Frequency of her ethanol consumption actually is. Our Specific Aims are to test two hypotheses. HYPOTHESIS 1: Eligible women who abuse alcohol and who are provided with intensive education and careful quantification of their ethanol consumption (Group 1, Early Start Plus, or intervention arm) will have better perinatal outcomes (e.g., lower rates of neonatal assisted ventilation) than eligible women who simply receive confidential counseling (Group 2, Early Start, or "usual care" arm). Women in these two groups will have significantly better perinatal outcomes than those who receive no counseling at all (Group 3, comparison arm). HYPOTHESIS 2: Substance abusing women in Group 1 (Early Start Plus) will have higher rates of abstinence or cutting down on their drinking than those in Group 2 (Early Start). Women in these two groups will have significantly higher rates of abstinence or cutting down on their drinking than those who receive no counseling at all (Group 3, comparison arm). These hypotheses will be tested by randomizing 15 Early Start clinics to either the intervention or usual care arms. Each arm will consist of 7-8 obstetrics clinics. In addition, 2 KPMCP clinics where Early Start is not implemented will serve as comparison sites. We anticipate retaining 600 women in each of the 3 treatment arms during a 36 month period. We will then compare rates of a combined perinatal outcome measure (which includes mortality and morbidity) as well as decreases in maternal alcohol intake in the intervention, "usual care," and comparison arms. Our long term goals are to increase patient, provider, and policymaker awareness of the importance of alcohol abuse in pregnancy and to demonstrate the applicability of a simple, targeted intervention in a managed care organization.

怀孕期间酗酒是一个严重的问题。研究表明，1)禁欲是最好的策略，但怀孕期间减少饮酒是有益的；2)饮酒者低估了自己的酒精消耗量；3)支持性咨询比客观或纯粹的医学方法更好；4)在支持性环境中，对健康婴儿的渴望是一个强大的动机。我们建议在一个成熟的管理型医疗组织中测试一个简单的干预措施。Kaiser Permanente医疗保健计划在加利福尼亚州的15家产科诊所实施了一项名为早期开始的减少药物滥用危害的计划。我们建议通过帮助女性认识到她们喝了多少酒来促进早期开始。我们将使用样本容器、类似容器的照片，以及一个简单的软件应用程序，该应用程序允许顾问向孕妇展示她实际的酒精摄入量和频率。我们的具体目标是检验两个假说。假设1：与只接受保密咨询的合格妇女(第2组，早期开始或“常规护理”ARM)相比，符合条件的酗酒妇女接受了强化教育并仔细量化了她们的酒精摄入量(第1组，早期开始治疗或干预组)，她们的围产期结局(例如，较低的新生儿辅助通气率)将更好。这两组妇女的围产期结局将明显好于那些根本没有接受咨询的妇女(第三组，对比组)。假设2：第一组(早期开始)滥用药物的女性将比第二组(早期开始)的女性有更高的禁酒率或饮酒率。这两组女性的禁酒率或饮酒率明显高于那些根本没有接受咨询的女性(第三组，对比组)。这些假设将通过随机将15个早期开始的诊所分配到干预组或常规护理组进行检验。每个分支机构将由7-8个产科诊所组成。此外，两个未实施提前启动的毕马威诊所将作为比较地点。我们预计在36个月的时间里，在3个治疗部门中各保留600名妇女。然后，我们将比较综合围产期结局测量(包括死亡率和发病率)的比率，以及干预组、“日常护理”组和对照组中母亲酒精摄入量的减少。我们的长期目标是提高患者、提供者和政策制定者对酒精滥用在怀孕期间的重要性的认识，并证明简单、有针对性的干预在管理型医疗组织中的适用性。