COMPUTER ALGORITHMS FOR ALCOHOL DISORDERS IN THE ELDERLY

本研究是一项关于计算机化酒精相关问题系统（CARPS）的有效性和可行性的随机试验，CARPS是一种自我管理的筛查，用于检测和报告老年人非危险、危险和有害的酒精使用情况。CARPS包括可扫描版本的可靠酒精筛查，每个患者饮酒分类的个性化报告，个性化酒精教育，以及在关系数据库中存储响应的能力。由于缺乏针对老年人的有效和可用的筛查，因此开发了CARPS。在老年人中，由于与年龄相关的变化以及酒精、药物使用和功能状态下降之间的相互作用，每天喝一到两杯酒可能会加重常见的医学问题（如抑郁症）。大约40%的人可能处于危险之中；酒精问题的住院率与心肌梗死的住院率相等。在这项研究中，在社区实践的实验初级保健患者将被随机分配到两个实验组或对照组之一。在组1中，患者单独收到一份报告；在第二组，病人和医生都收到报告。对照组接受常规护理。我们通过检查知识和自我效能的改善以及酒精相关风险和健康服务利用率的降低来评估有效性。可行性是通过不显眼的观察来评估的。建议的商业应用：CARPS可用于所有卫生机构，以有效地筛查和诊断老年人的酒精使用障碍。这包括医生办公室和医疗诊所、老年中心和持续护理社区。管理式护理组织和健康保险公司特别关注检测和预防健康问题风险的有效方法，并将发现该产品有益，特别是因为没有其他类似的产品可用。CARPS是用户友好的。它可以用于质量改进活动和研究以及临床护理。

This study is a randomized trial of the effectiveness and feasibility of the Computerized Alcohol-Related Problems System (CARPS), a self- administered screen to detect and report on non-hazardous, hazardous and harmful alcohol use in older adults. The CARPS consists of a scannable version of a reliable alcohol screen, a personalized Report of each patient's drinking classification, individualized alcohol education, and the capacity to store responses in a relational database. The CARPS was developed because of the paucity of effective and usable screens for older adults. In the elderly, one or two daily drinks may worsen common medical problems (e.g., depression) because of age-related changes and interactions between alcohol, medication-use and diminishing functional status. About 40% may be at risk; hospitalization rates for alcohol problems equal those for myocardial infarction. In this study, experimental primary care patients at a community practice will be randomly assigned to one of two experimental groups or a control. In Group 1, patients alone receive a Report; in Group 2, patients and physicians both receive Reports. The control group receives usual care. Effectiveness us evaluated by examining improvements in knowledge and self-efficacy and reductions in alcohol-related risks and health services utilization. Feasibility is evaluated by unobtrusive observations. PROPOSED COMMERCIAL APPLICATIONS: The CARPS can be used in all health settings to efficiently screen for and diagnose alcohol use disorders in the elderly. This includes physicians' offices and medical clinics, senior centers, and continuing care communities. Managed care organizations and health insurers are particularly concerned with efficient methods of detecting and preventing risks for health problems and will find the product beneficial, especially because no other product like it is available. The CARPS is user friendly. It can be used in quality improvement activities and research as well as in clinical care.