Brief Intervention in the ER in Poland

对波兰急诊室的简短干预

• 批准号: 7209884
• 负责人: CHERYL J CHERPITEL
• 金额: $ 18.28万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-03-05 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7209884
• 关键词: Accident and Emergency department; Address; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcoholic beverage heavy drinker; Alcohols; American College of Surgeons; Analysis of Variance; Applications Grants; Biological; Blinded; Caring; Charge; Cities; Consent; Consumption; Country; Cultural Characteristics; Data; Data Collection; Development; Disease regression; Early identification; Effectiveness; Effectiveness of Interventions; Emergency Medicine; Environment; Equation; Esthesia; European; Evaluation; Event; Feasibility Studies; Funding; Geographic Locations; Guidelines; Health; Health Services Accessibility; Healthcare Systems; Heavy Drinking; Human Resources; Impulsivity; Injury; International; Intervention; Intervention Studies; Intervention Trial; Knowledge; Laboratories; Lead; Logistic Regressions; National Institute on Alcohol Abuse and Alcoholism; Neuro-Oncological Ventral Antigen 2; Numbers; Nurses; Outcome; Outcome Assessment; Patient Self-Report; Patients; Pattern; Physicians; Poland; Policies; Polishes; Population; Prevalence; Primary Health Care; Protocols documentation; Provider; Public Hospitals; Quality of life; Randomized; Rate; Readiness; Relative (related person); Research; Research Personnel; Risk; Risk-Taking; Sampling; Score; Screening procedure; Selection Bias; Services; Site; Staging; Standards of Weights and Measures; Substance of Abuse; System; Techniques; Testing; Thinking; Time; Training; Translating; Trauma; Treatment Protocols; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Visit; Week; alcohol abuse therapy; alcohol related problem; alcohol use disorder; breath alcohol measurement; care seeking; cost; day; drinking; early /brief intervention /therapy; follow-up; injured; motivational enhancement therapy; motivational intervention; problem drinker; programs; social; trauma centers; willingness

DESCRIPTION (provided by applicant): The aims of this Developmental Grant Proposal for Collaborative International Projects are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) using a nurse-delivered motivational intervention, relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS + 6) in the emergency room (ER) in Sosnowiec, Poland; and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine SBIRT study to a non-academic ER setting outside of the U.S. The SBIRT study, recently funded by NIAAA and SAMHSA, is the first multisite, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ER. We will conduct a blinded randomized brief motivational intervention trial in which both injured and noninjured patients over the aged of 18 will be screened for at-risk or dependent (using the RAPS4) drinking. Those screening positive will be asked to participate in the study. Consenting patients will be randomized into one of three groups: screened only, assessed, and brief intervention, with n=292 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk taking disposition and readiness and stage of change. Prior research in the ER in Sosnowiec and a pilot feasibility study of SBIRT in Sosnowiec suggest: 1) a large number of "at risk", heavy problem and dependent drinkers who meet screening criteria for brief intervention in a relatively short period of time; 2) a socialized health care system which provides equal access to care and is not subject to selection bias affecting patient access; 3) a patient sample covering a large geographic area; 4) a stable environment facilitating high follow-up rates post-intervention; and, 5) a well integrated referral system and high accessibility to alcohol treatment services. Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. The ER is an important setting for screening and brief intervention for those with alcohol-related problems in order to reduce subsequent alcohol-related ER visits and associated costs and increase quality of life. This project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ER, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes.

说明（由申请人提供）：本国际合作项目发展拨款提案的目的是：1) 相对于有或没有评估的标准护理，检查使用护士提供的动机干预的筛查、简短干预和转诊治疗 (SBIRT) 在减少酗酒（每周饮酒天数、每天饮酒次数、一次最大饮酒次数）和酒精相关问题（RAPS4 和 SIPS + 6）方面的有效性 在波兰索斯诺维茨的急诊室 (ER)； 2) 确定与干预有效性相关并预测成功治疗结果的变量。我们计划将在初级保健中取得成功并最近在美国 14 学术急诊医学 SBIRT 研究中实施的激励干预措施转化为美国以外的非学术急诊环境。SBIRT 研究最近由 NIAAA 和 SAMHSA 资助，是第一个针对急诊室高危饮酒和依赖饮酒的筛查、简短干预和转诊的多地点合作研究。我们将进行一项盲法随机简短动机干预试验，对 18 岁以上的受伤和未受伤患者进行饮酒风险或依赖性（使用 RAPS4）筛查。那些筛查呈阳性的人将被要求参加该研究。同意的患者将被随机分为三组之一：仅筛查组、评估组和简短干预组，每组 n=292。干预组和评估组将在 3 个月时进行随访，所有三组将在 12 个月时进行随访。 修改变量包括事件中的饮酒、冒险倾向和准备情况以及变化阶段。索斯诺维茨急诊室的先前研究和索斯诺维茨 SBIRT 的试点可行性研究表明：1）大量“处于危险中”、有严重问题和依赖性饮酒者符合在相对较短的时间内进行短暂干预的筛选标准； 2) 社会化的医疗保健体系，提供平等的医疗服务，并且不会受到影响患者获得医疗服务的选择偏见的影响； 3) 覆盖较大地理区域的患者样本； 4) 稳定的环境有利于干预后的高随访率； 5) 完善的转诊系统和酒精治疗服务的便捷性。结果数据将使用方差分析、逻辑回归和广义估计方程进行分析。还将分析修改变量对结果的相互作用。急诊室是对患有酒精相关问题的人进行筛查和短暂干预的重要场所，以减少随后因酒精相关的急诊就诊和相关费用，并提高生活质量。该项目将为更有效的技术和方案的开发和传播提供信息，以解决急诊室中的高危饮酒和依赖饮酒问题，并更好地了解影响短期干预有效性和预测患者成功结果的因素。