Multidisciplinary Approach to Reduce Injury and Substance Abuse

描述(由申请者提供)：美国外科医师学会(ACS)最近建立了I级创伤中心的要求，为酒精问题提供筛查和短暂干预(SBI)。这项任务的动力是支持对受伤患者进行短暂酒精干预在减少酒精使用和未来受伤风险以及节省成本方面的有效性的证据基础。然而，缺乏关于履行机构在药物使用方面的有效性的证据。此外，几乎没有证据表明药物SBI对艾滋病毒风险和与药物使用密切相关的其他健康后果的有效性。 本申请提出了一项随机临床试验，评估简短建议(BA)、简短反馈激励干预(BMI)和简短反馈激励干预(BMI B)在有药物问题的受伤患者中的有效性。环境是一个创伤中心，为大量和多样化的患者提供服务。人们感兴趣的主要结果将是随后的药物使用。其他令人感兴趣的结果包括：(A)艾滋病毒相关危险行为，(B)改善健康结果，包括减少伤害，(C)增加就业，(D)减少从事非法行为，(E)增加药物滥用治疗的使用率，以及(E)在3个月、6个月和12个月的随访中提高生活质量。 这项研究还将考察患者对改变的准备程度、对改变的经验和行为过程的使用以及决策平衡考虑的潜在调节和调节作用。此外，该项目还将审查组织层面的实施因素以及BA、BMI和BMI B的成本效益。 拟议研究的资金将增加关于对有药物使用问题的受伤患者进行短暂干预的有效性的知识库，从而为创伤护理环境中的药物使用问题的筛查、短暂干预和转介提供必要的证据基础。 与公共卫生相关：与任何其他可预防的疾病相比，药物滥用导致的死亡、疾病和残疾更多。这项研究将增加关于在创伤中心和其他医疗机构中对有药物使用问题的受伤患者进行简短筛查和干预的有效性的知识库，从而减少与药物使用相关的伤害和相关的健康后果。

DESCRIPTION (provided by applicant): The American College of Surgeons (ACS) recently established requirements for Level I Trauma Centers to provide screening and brief intervention (SBI) for alcohol problems. The impetus for this mandate was the evidence base supporting the effectiveness of brief alcohol interventions with injured patients on reducing alcohol use and risk of future injury, as well as cost savings. However, there is a lack of evidence regarding the effectiveness of SBI for drug use. In addition, there is little evidence on the effectiveness of drug SBI on HIV risk and other health outcomes strongly associated with drug use. This application proposes a randomized clinical trial evaluating the effectiveness of brief advice (BA), brief motivational intervention with feedback (BMI), and brief motivational intervention with feedback and booster (BMI+B) in injured patients with drug problems. The setting is a trauma center serving a large and diverse patient population. The primary outcome of interest will be subsequent drug use. Other outcomes of interest include: (a) HIV-related risk behaviors, (b) improved health outcomes including injury reduction, (c) increased employment, (d) decreased engagement in illegal behavior (e) increased substance abuse treatment utilization, and (e) enhanced quality of life at three, six, and twelve month follow-ups. This study will also examine the potential moderating and mediating effects of patient readiness to change, use of experiential and behavioral processes of change and decisional balance considerations. In addition, this project will examine implementation factors at the organizational level and the cost effectiveness of BA, BMI, and BMI+B. Funding of the proposed study will increase the knowledge base with regard to the effectiveness of brief intervention among injured patients with drug use problems and, thereby, provide the ACS and the field with the necessary evidence base for screening, brief intervention and referral for treatment for drug use problems in the trauma care setting. PUBLIC HEALTH RELEVANCE: More deaths, illness and disabilities are attributed to substance misuse than any other preventable condition. This study will increase the knowledge base regarding the effectiveness of brief screening and intervention among injured patients with drug use problems in trauma centers and other medical settings, thus leading to reduced injury and related health outcomes associated with drug use.