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

描述(申请人提供)：这是“青少年AOD使用筛查：对初级保健提供者的研究”的续订。卫生系统尚未对青少年实施筛查、短期干预和转诊治疗(SBIRT)，尽管研究表明其有效性。基于先前的研究确定了在儿科初级保健(PC)中对青少年进行AOD筛查的障碍，以及一项试点研究发现SBIRT是可行的、广受欢迎的并促进了转诊和开始专科治疗，当前的研究申请建议将北加州凯撒永久保健系统内医疗中心儿科诊所的初级保健医生(PCP)随机分为三类-1)普通护理；2)由PCP提供的SBIRT；以及3)由行为医学专家(BMS)提供的SBIRT。本研究的目的是比较SBIRT在三个研究组中对PC青少年的实施情况、效果和成本-效果。患者将完成基于证据的筛查和AOD评估措施，这些措施已嵌入医疗计划的电子病历(EMR)。在12个月时，将使用混合模型来比较实施结果(筛查和识别、短暂干预、转诊至化学依赖治疗和治疗初始)和有效性(AOD使用和戒除的患者结果)。该模型考虑了提供者内患者之间的类内相关性。将检查与实施和患者结果相关的成本效益。还将审查实施的障碍和促进者，以及通过与临床医生和管理人员的定性访谈来实现的可行性。这项研究具有重要意义，因为它研究了必须解决的问题，以促进SBIRT的广泛适应。由于联邦合格的保健中心和私人保健计划的资源和培训增加，在当前的卫生改革环境下，拟议的联席会议是非常可行的。在利用电子病历改变临床实践、将AOD系统集成到PC中以及作为收集研究数据的平台方面具有创新性。 公共卫生相关性：AOD问题普遍存在，对青少年具有破坏性，对社会来说代价高昂，及早发现和干预可产生重大影响。我们研究如何以广泛适用的方式有效和经济地识别和干预。这项研究为卫生系统和临床医生将AOD服务纳入初级保健的主流提供了关键信息，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.