Brief Intervention in Primary Care for Problem Drug Use and Abuse

描述(由申请人提供)：大量研究已经确定了对在医疗环境中看到的患者使用危险酒精的短暂干预(BI)的有效性，促使实施了大规模筛查和短暂干预“物质滥用”的传播项目。然而，很少有研究考察BI在医疗环境中对问题药物的使用和滥用的有效性，并且在实际构成BI的方面存在相当大的差异(即，哪些是重要的或有效的治疗成分)。与医疗环境中未经治疗的药物滥用有关的潜在成本是巨大的。尽管滥用者会遭受巨大的人类痛苦和发病率，但潜在的医疗成本节省和与BI相关的不良医疗后果的减少很可能是政策变化的主要驱动因素，以改善BI治疗的提供。因此，本申请建议根据有关BI和酒精使用的文献，进行一项具有广泛外部效度的政策性临床试验(“功效-效果”混合研究)，以评估在大型安全网医院的初级保健医疗环境中出现问题药物使用和滥用的患者中，BI和转介治疗的有效性。这项研究有四个目标：(1)确定BI在减少药物使用和增加完全转诊到治疗(即治疗开始)方面是否有效；(2)测试强调激励性访谈的BI模型的高保真度是否比低保真度更有效；(3)估计BI对几种公共健康结果的影响；(4)基于医疗服务使用和药物使用频率，从支付者的角度估计干预的成本、潜在的成本抵消和增量成本效益。公共卫生相关性：该项目正在评估一项干预措施的有效性，该干预措施最近已被批准为医疗保健环境中的一项收费服务，尽管缺乏数据支持其在药物滥用和依赖中的使用。这项研究的结果将对是否可取地将其应用范围扩大到危险的酒精滥用之外，包括药物滥用。

DESCRIPTION (provided by applicant): A substantial body of research has established the effectiveness of brief interventions (BI) for hazardous alcohol use in patients seen in medical settings, prompting the implementation of dissemination projects of screening and brief intervention for "substance abuse" on a widespread scale. However, there are few studies examining the efficacy of BI for problem drug use and abuse in medical settings, and there is considerable variability in what actually constitutes a BI (i.e., what are the important or active therapeutic ingredients). The potential costs related to untreated drug abuse in medical settings are substantial. Although there is great human suffering and morbidity for the abuser, it is likely that potential healthcare cost savings and decreased adverse healthcare outcomes related to BI will be the major drivers of policy change to improve provision of BI treatment. Accordingly, this application proposes to conduct a policy-relevant clinical trial with broad external validity (a hybrid "efficacy-effectiveness" study) informed by the literature on BI and alcohol use, to evaluate the efficacy of BI and referral to treatment when indicated, in patients with problem drug use and abuse seen in the primary care medical setting at a large safety-net hospital. The study has four aims: (1) to determine if BI is effective in reducing drug use and increasing completed referral to treatment (i.e., treatment initiation); (2) to test whether higher fidelity to a BI model that emphasizes motivational interviewing is more effective than lower fidelity; (3) to estimate the impact of BI on several public health outcomes; (4) to estimate the costs of the intervention, potential cost offsets, and incremental cost-effectiveness from the payer perspective based on health care service use and drug use frequency. PUBLIC HEALTH RELEVANCE: This project is evaluating the effectiveness of an intervention that has recently been approved as a billable service in the medical care setting, despite the absence of data supporting its use in drug abuse and dependence. The results of the study will have implications for whether it is advisable to expand its application beyond hazardous alcohol abuse to include abuse of drugs.