Preventing Drug Use in Low Income Clinic Populations

预防低收入诊所人群吸毒

基本信息

批准号：
7923181
负责人：
Lillian Gelberg
金额：
$ 59.85万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7923181
关键词：
Absenteeism Abstinence Address Adult Age Alcohol abuse Alcohol or Other Drugs use Alcohols Amphetamines Area Behavior Behavioral Brain Cannabis Caring Cigarette Clinic Cocaine Community Health Centers Computer Assisted Computers Consent Control Groups Coronary Arteriosclerosis Counseling County Crime Dependence Development Drug Addiction Drug usage Early Diagnosis Eating Eligibility Determination Goals HIV Health Health Educators Health Policy Health Promotion Health behavior Health education Heroin Individual Informed Consent Inpatients Intervention Intervention Trial Legal Los Angeles Low income Measures Mental Depression Methods Misinformation Mission Modeling Occupations Pathway interactions Patient Self-Report Patients Pharmaceutical Preparations Physical activity Physicians Physiological Policy Maker Population Population Heterogeneity Preclinical Drug Evaluation Prevention Prevention Research Primary Care Physician Primary Health Care Process Protocols documentation Public Health Randomized Randomized Controlled Trials Recording of previous events Recruitment Activity Reporting Risk Risk Assessment Risk Behaviors Sample Size Sampling Screening procedure Seat Belts Single-Blind Study Site Smoke Social support Substance abuse problem System Technology Telephone Testing Time Tobacco Unemployment United States Visit addiction alcohol testing base behavior change brief intervention computerized design disability drug abuse prevention drug of abuse follow up assessment health care service utilization health related quality of life meetings patient population prevent primary care setting programs psychologic public health relevance safety net social socioeconomics standard care theories vehicular accident

项目摘要

DESCRIPTION (provided by applicant): The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing `at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at 2 safety net clinics in Los Angeles County. For this small trial, we will sample patients with `at risk' use of stimulants (cocaine or amphetamines), the most commonly used serious drugs among patients at our clinic sites. "At risk" stimulant use is defined in this study as current use (past 90 days) of stimulants measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 8,000 patients will be approached for screening to yield a 12-month effective sample size of 200 eligible patients per condition (1) an intervention condition or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting stimulants use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting stimulant use and cautioning against use of other `at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician, which will be followed by two post-visit telephone health education sessions that will be of equal duration as the intervention sessions but will address healthy eating, physical activity, and seat belt use. Follow- up assessments will be conducted at 6 and 12 months post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone stimulant-use health education program could become a model for health promotion activities. that would be expanded to all `at risk' substance use and shared between community health centers. PUBLIC HEALTH RELEVANCE: The proposed study will address the critical need to reduce illegal drug use, in particular stimulant use, and the occurrence of drug-related harm in low-income racially diverse patient populations at urban primary care safety-net clinics. At risk for accelerated trajectories to drug dependence once drug use begins, low-income racially diverse populations pose particular concern for public health policy makers and drug-use prevention efforts. The study will be the first of its kind to standardize drug screening and physician brief intervention among racially diverse "at risk" stimulant users, that is casual or frequent use without the physiological or psychological manifestations of dependence, and it may effectively interrupt their pathway to dependence.

描述（由申请人提供）：使用药物干预试验（退出）戒烟将是美国的第一个随机对照试验，该试验有动力检测一名初级保健临床医生提供的简短干预方案的效果，以减少2种毒品使用和降低2个安全网络（18岁及以上）在Los Angeles县的低收入成人患者（18岁及以上的年龄）。对于这项小型试验，我们将对使用刺激剂（可卡因或苯丙胺）的患者进行采样，这是我们诊所部位中最常用的严重药物。在本研究中，将“处于危险”的兴奋剂使用定义为在WHO酒精物质参与筛查测试（Assist）上以自我报告的总分为4至26的兴奋剂的当前使用（过去90天）。总共将接触8,000名患者进行筛查，以产生12个月的有效样本大小为200名合格的患者（1）干预条件或（2）涉及护理的对照条件。在干预条件下，临床医生关于退出兴奋剂使用的建议非常简短（少于5分钟），然后将在访问后的两次和6周进行戒烟刺激性使用，并警告不要使用其他“处于危险”的药物（例如酒精和烟草）。分配给控制条件的患者将在与临床医生的基线访问中获得标准护理，随后进行两次参观后电话健康教育课程，这些课程将在干预课程中持续相等，但将解决健康的饮食，体育锻炼，安全带的使用。随机评估将在随机化后6个月和12个月进行。退出项目的框架是社会诉讼理论，简短的干预协议基于NIDA关于预防研究的原则以及5 A在临床环境中协助患者行为改变（询问，建议，评估，协助，安排）的方法的实用性。如果发现在社区健康中心环境中有效，该临床医生和电话刺激性健康教育计划可能会成为健康促进活动的典范。这将扩展到社区卫生中心之间的所有“处于风险”的物质使用和共享。公共卫生相关性：拟议的研究将解决减少非法使用药物使用，特别是兴奋性使用的关键需求，以及在城市初级保健安全网诊所中低收入种族多样的患者人群中与药物有关的危害的发生。一旦开始使用药物毒品，就有加速轨迹涉及药物依赖的风险，低收入种族多样性的人群对公共卫生政策制定者和毒品使用预防工作特别关注。这项研究将是在种族多样化的“风险”兴奋剂使用者中标准化药物筛查和医师对药物筛查和医师短暂干预的第一个此类研究，这是随意或频繁使用的情况下，而没有依赖的生理或心理表现，并且可能有效地中断了他们依赖的途径。