IVR for Automated Alcohol Screening & BI in Primary Care

描述（由申请人提供）：这是一项R21申请，旨在对交互式语音应答（IVR）进行探索性/开发性研究，将其作为一种工具，用于在初级保健环境中对重度/问题饮酒进行自动筛查和简短干预。有压倒性的证据表明，由初级保健提供者进行的短暂酒精干预（BI）可有效减少患者中的风险饮酒。但是，也有证据表明，初级保健提供者对筛查和BI的利用严重不足。 可能的解释包括缺乏时间、提供者缺乏对其患者的消费水平的认识、提供者对行为干预的不适、提供者对BI的功效的怀疑以及缺乏对预防性服务的报销。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，有人呼吁自动化筛查和简短干预。到目前为止，大多数努力都是基于计算机的，没有在初级保健环境中广泛测试。虽然基于计算机的方法值得进一步研究，但它们并不是理想的解决方案。计算机化需要现场计算机硬件和软件、技术支持以及诊所工作人员时间来启动患者的筛查和BI，其中一些患者可能会被计算机吓倒。这是一项持续的财政投资，不鼓励在大多数诊所使用。 该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方法，该方法价格低廉，使用熟悉且几乎通用的技术（按键式电话），基本上不需要临床工作人员的时间。如果该开发项目成功，我们将使用所得数据作为后续随机对照试验的基础，以比较基于IVR的BI与由初级保健提供者进行的BI的功效。方法：本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），该工具对患者来说是可接受的，对提供者来说是实用的，并且对于识别适合进行短暂干预的患者是有效的。完成第一阶段后，在第二阶段，我们将开发一种基于IVR的简短干预工具（IVR-BI），并在IVR-Screen呈阳性且适合酒精简短干预的临床患者中测试其接受程度。虽然这不是一项疗效研究，但我们还将评估IVR-BI是否对这一小规模可行性样本中的饮酒量产生短期影响。

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.