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

青少年酗酒和吸毒筛查：初级保健提供者的研究

• 批准号: 8186477
• 负责人: CONSTANCE M. WEISNER
• 金额: $ 57.76万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8186477
• 关键词: Abstinence; Accounting; Address; Administrator; Adolescent; Adult; Affect; Alcohol consumption; Attitude; Behavioral Medicine; Beryllium; California; Characteristics; Chemicals; Childhood; Clinic; Clinical; Comorbidity; Computerized Medical Record; Data; Dependency; Development; Drug usage; Early Diagnosis; Early identification; Early treatment; Effectiveness; Environment; Family; Federally Qualified Health Center; Goals; Health; Health Information System; Health Planning; Health system; Healthcare; Home environment; Insurance; Intervention; Interview; Knowledge; Laboratories; Legal; Mainstreaming; Managed Care; Marijuana; Measures; Medical; Medical center; Mental Health; Modeling; Monitor; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Study; Patients; Pattern; Pediatrics; Pilot Projects; Policy Maker; Preclinical Drug Evaluation; Primary Care Physician; Primary Health Care; Process; Provider; Questionnaires; Randomized; Relative (related person); Research; Resources; Role; Schools; Screening procedure; Services; Societies; Specialist; Statutes and Laws; Structure; Surveys; Teenagers; Testing; Training; Treatment Protocols; Visit; Youth; adolescent alcohol; alcohol and other drug; arm; base; brief intervention; clinical practice; compare effectiveness; cost; cost effective; cost effectiveness; evidence base; follow-up; improved; innovation; medical specialties; parity; screening and brief intervention; screening, brief intervention, referral, and treatment; three-arm study; tool; treatment as usual

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.

描述（由申请人提供）：这是一个更新的“筛选青年AOD用途：一项研究的初级保健提供者。卫生系统尚未对青少年实施筛查、短期干预和转诊治疗，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，以及一项发现SBIRT是可行的、广受欢迎的、促进转诊和启动专科治疗的试点研究，当前的研究申请建议在一个大型管理式保健卫生系统内的医疗中心的儿科诊所中随机分配初级保健医生（PCP），Kaiser Permanente北方加州，分为三个组：1）家庭护理; 2）PCP提供的SBIRT; 3）行为医学专家（BMS）提供的SBIRT。本研究的目的是比较三个研究组中SBIRT在PC青少年中的实施情况、有效性和成本效益。患者将完成循证筛查和AOD评估措施，这些措施已嵌入健康计划的电子病历（EMR）中。将使用混合模型比较12个月时的实施结局（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局）。该模型考虑了提供者内患者之间的类内相关性。将检查相对于实施和患者结局的成本效益。实施的障碍和促进因素，以及通过与临床医生和管理人员的定性访谈的可行性也将进行研究。这项研究是重要的，因为它探讨了必须解决的问题，以刺激广泛适应SBIRT。在当前的卫生改革环境下，由于联邦合格卫生中心和私人卫生计划的资源和培训增加，拟议的干预措施是非常可行的。它是创新性的使用电子病历改变临床实践和系统集成在PC上的AOD，并作为一个平台，收集研究数据。 公共卫生相关性：AOD问题对青少年来说是普遍和毁灭性的，对社会也是昂贵的，早期发现和干预可以产生关键的影响。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提供了关键信息，以将AOD服务纳入初级保健的主流，并对AOD领域“医疗之家”概念的发展产生影响。