IVR for Automated Alcohol Screening & BI in Primary Care

描述(由申请人提供)：这是一份R21申请，旨在对交互式语音应答(IVR)进行探索性/发展性研究，作为一种工具，用于在初级保健环境中对重度/有问题的饮酒进行自动筛查和简短干预。有压倒性的证据表明，初级保健提供者的短暂酒精干预(Bl)在减少患者中有风险的饮酒方面是有效的。但是，也有证据表明，初级保健提供者对筛查和B1的利用严重不足。 可能的原因包括缺乏时间，提供者缺乏对患者消费水平的认识，提供者对行为干预感到不适，提供者对bl的有效性持怀疑态度，以及缺乏预防性服务的报销。测试有针对性的教育和/或提供者鼓励的影响的研究结果令人失望。作为回应，有人呼吁自动筛查和短暂干预。到目前为止，大多数努力都是基于计算机的，并没有在初级保健环境中进行广泛的测试。尽管基于计算机的方法值得进一步追求，但它们并不是理想的解决方案。计算机化需要现场的计算机硬件和软件、技术支持和诊所工作人员的时间来启动对患者的筛查和治疗，其中一些人可能会被计算机吓倒。这是一项持续的财务投资，不鼓励在大多数诊所使用。 此R21应用程序是一项探索性工作，旨在测试电话技术(IVR)作为酒精筛查和简短干预的一种方法，该方法成本低廉，使用一种熟悉且几乎通用的技术(按键电话)，基本上不需要临床工作人员的时间。如果这一开发项目成功，我们将使用结果数据作为后续随机对照试验的基础，比较基于IVR的B1和初级保健提供者所做的B1的疗效。方法：研究分两个阶段进行。在第一阶段，我们将创建一个基于IVR的筛查工具(IVR-Screen)，它对患者来说是可以接受的，对提供者来说是实用的，并且可以有效地识别适合进行短暂干预的患者。在完成第一阶段后，在第二阶段，我们将开发基于IVR的短暂干预工具(IVR-BI)，并测试其在IVR筛查呈阳性且适合进行酒精短暂干预的临床患者中的接受性。虽然这不是一项疗效研究，但我们也将在这个小的可行性样本中评估IVR-BI是否对酒精消费有短期影响。

DESCRIPTION (provided by applicant): This is an R21 application for an exploratory /developmental study of Interactive Voice Response (IVR) as a tool for automated screening and brief intervention for heavy/problem drinking in primary care settings. There is overwhelming evidence that a brief alcohol intervention (Bl) by a primary care provider is effective in reducing at-risk drinking among patients. But, there is also evidence that screening and Bl are grossly underutilized by primary care providers. Possible explanations include lack of time, lack of provider awareness of their patients' consumption level, provider discomfort with behavioral interventions, provider doubts about the efficacy of Bl, and lack of reimbursement for preventive services. The results of studies testing the impact of targeted education and/or provider encouragement have been disappointing. In response, there have been calls for automating screening and brief intervention. Most efforts so far have been computer based and not widely tested in primary care settings. While computer-based approaches are worthy of further pursuit, they are not an ideal solution. Computerization requires on-site computer hardware and software, technical support, and clinic staff time to initiate the screening & Bl with patients, some of whom may be intimidated by computers. This is an ongoing financial investment that discourages use in most clinics. This R21 application is for an exploratory effort to test a telephone technology (IVR) as a method of alcohol screening and brief intervention that is inexpensive, uses a familiar and nearly universal technology (touch-tone telephones), and requires essentially no clinical staff time. If this developmental project is successful, we will use the resulting data as a basis for a subsequent randomized controlled trial of the efficacy of IVR-based Bl compared to Bl done by primary care providers. Methods: The study will be done in two phases. In Phase I, we will create an IVR-based screening tool (IVR-Screen) that is acceptable to patients, utilitarian for providers, and valid for identifying patients who are appropriate for brief intervention. After completing Phase I, in Phase II we will develop an IVR-based brief intervention tool (IVR-BI) and test its acceptance among clinic patients who are positive on the IVR-Screen and are appropriate for alcohol brief intervention. Although this is not an efficacy study, we will also assess whether the IVR-BI has a short-term impact on alcohol consumption in this small feasibility sample.