HOW MUCH DOES SHE REALLY DRINK? AN HMO INTERVENTION

她到底喝了多少？

• 批准号: 6371599
• 负责人: GABRIEL J. ESCOBAR
• 金额: $ 22.39万
• 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/6371599
• 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.

怀孕期间酗酒是个严重的问题。研究表明：1)戒酒是最佳策略，但在怀孕期间减少饮酒量是有益的；2)饮酒者低估了他们的乙醇消耗量；3)支持性咨询比非个人或纯粹的医疗方法更好；4)在一个支持性的环境中，对健康宝宝的渴望是一个强大的动力。我们建议在一个成熟的管理式医疗机构中测试一个简单的干预措施。Kaiser Permanente医疗保健计划在加州的15家产科诊所实施了一项名为“早期开始”的药物滥用危害减少计划。我们建议通过帮助女性认识到她们喝了多少酒来加强“早期开始”。我们将使用样品容器，类似容器的照片，以及一个简单的软件应用程序，该应用程序允许咨询师向孕妇展示她实际摄入乙醇的数量和频率。我们的具体目标是检验两个假设。假设1：与仅接受保密咨询（2组，早期启动或“常规护理”组）的合格妇女相比，滥用酒精并接受强化教育和仔细量化其乙醇摄入量的合格妇女（1组，早期启动+或干预组）将有更好的围产期结局（例如，新生儿辅助通气率较低）。这两组妇女的围产儿结局明显优于未接受咨询的妇女（第三组，比较组）。假设2：第1组（提早开始+）的药物滥用妇女比第2组（提早开始）的妇女戒酒或减少饮酒的比率更高。这两组的女性戒酒或减少饮酒量的比例明显高于那些根本没有接受咨询的女性（第三组，比较组）。这些假设将通过随机选取15家Early Start诊所进行干预组或常规护理组来验证。每个分支将包括7-8个产科诊所。此外，2个未实施“早期启动”的KPMCP诊所将作为比较地点。我们预计在36个月的时间里，三个治疗组各保留600名妇女。然后，我们将比较综合围产期结果测量（包括死亡率和发病率）的比率，以及干预组、“常规护理”组和比较组中产妇酒精摄入量的减少。我们的长期目标是提高患者、提供者和政策制定者对孕期酒精滥用重要性的认识，并证明在管理式医疗机构中简单、有针对性的干预措施的适用性。