Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

描述（由申请人提供）：这是“青少年 AOD 使用筛查：对初级保健提供者的一项研究”的更新。尽管有研究证明其有效性，但卫生系统尚未对青少年实施筛查、简短干预和转诊治疗 (SBIRT)。根据之前的研究，确定了儿科初级保健 (PC) 中青少年 AOD 筛查的障碍，并且一项试点研究发现，SBIRT 是可行的、受到好评的，并促进了转诊和开始专业治疗，当前的研究申请提议将北加州 Kaiser Permanente 大型管理医疗中心的儿科诊所的初级保健医生 (PCP) 随机分为三个组 - 1) 由 PCP 提供的 SBIRT；以及 3) 由行为医学专家 (BMS) 提供的 SBIRT。 该研究的目的是比较三个研究组中 PCP 青少年的 SBIRT 实施情况、有效性和成本效益。已嵌入健康计划电子病历 (EMR) 中的基于证据的筛查和 AOD 评估措施将用于比较 12 个月的实施结果（筛查和识别率、简短干预、转诊至化学依赖性治疗和治疗启动）和有效性（AOD 使用和戒断的患者结果）。还将审查实施的促进者以及通过与临床医生和管理人员进行定性访谈的可行性。该研究的意义在于，它研究了促进 SBIRT 广泛采用所必须解决的问题，因为联邦合格的卫生中心和私人健康计划的资源和培训有所增加，它在使用 EMR 改变临床实践和系统地将 AOD 纳入 PC 方面具有创新性。 公共卫生相关性：AOD 问题普遍存在，对青少年来说具有破坏性，而且社会成本高昂，早期发现和干预可以产生重大影响。我们研究如何以广泛适用的方式有效且经济地识别和干预。该研究为卫生系统和临床医生将 AOD 服务纳入初级保健主流提供了重要信息，并对 AOD 领域“医疗之家”概念的发展具有影响。

DESCRIPTION (provided by applicant): This is a renewal of "Screening for Youth AOD Use: A Study of Primary Care Providers. Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiaion), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed intereventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data. PUBLIC HEALTH RELEVANCE: AOD problems are prevalent and devastating for adolescents, as well as costly to society, and early detection and intervention can make a critical difference. We study how to identify and intervene effectively and economically in ways that are widely adaptable. The study provides critical information for health systems and clinicians to mainstream AOD services in primary care and has implications for the development of "medical home" concepts for the AOD field.