Web-based Biopsychosocial Assessment and Intervention for Alcohol Misuse

描述(申请人提供)：酒精滥用(AMU)给个人和社会造成了高昂的成本。及时的干预可以有效地减少影响，但AMU在实践中很少被发现和治疗。虽然AMU困扰着年轻、健康的人，但它也经常发生，叠加心理社会问题，这些问题也经常没有被发现。共同的主线是，医生缺乏时间和资源来进行完整的评估，以及适当地处理已发现的生物、心理、社会和健康行为问题。心理测量学的一个核心原则是，如果你想知道患者发生了什么，你必须询问患者--而不是提供者，也不是图表。如果你想了解AMU，必须直接询问患者；提供者不会知道，纸质问卷无法扩展为有效的解决方案。解决方案：我们的工作建立在一个可操作的、基于Web的患者自我评估系统CarePrep上，该系统允许患者从家里或诊所通过互联网轻松输入和跟踪症状、心理社会和生活质量数据。方法：(1)我们将在初级保健诊所部署CarePrep，解决任何政策和程序问题，并将该系统安装到护理路径中，目标是在患者就诊前对其进行评估。将进行患者测试，以确定和解决使用中的问题，并开始为AIM 2验证收集数据。(2)与酒精和心理测量学专家合作，我们将扩展和验证CarePrep，以在患者的生物心理社会问题的背景下筛查和评估AMU。我们将建立在审计等既定工具和既定领域和项目的基础上，重点是及早识别和评估AMU的依赖性和后果。在医疗设置中产生价值时，高度优先考虑，以便系统得到使用。临床相关性和结构效度将进行评估。我们将评估提供者和患者的可行性和接受性。影响：(1)初步开发和验证能够在相关生物、心理和社会问题背景下确定和评估医疗辅助组的在线资源。(2)综合干预，将AMU的筛查和简短干预嵌入到常规医疗护理的途径中，为提供者和患者创造价值，从而使系统得到使用。(3)研究共识资源的核心，它将常规的临床接触转化为研究机会，并支持对AMU的相关、透明的调查。 公共卫生相关性：这项工作采用了一个基于网络的患者自我评估系统，该系统目前正在临床上运行，以根据患者的医疗和心理社会问题识别和评估医疗环境中的酒精滥用。由于内科医生经常没有时间评估和提供简短的干预和持续护理，将开发在线系统，以尽可能独立地运行，以支持护理，告知临床医生患者的状况和问题。我们建议开发用于评估的问题，然后测试它们在患者中的有效性，以及患者和医生是否可以接受使用。长期目标是确定这种方法可以改善对酒精滥用的护理。

DESCRIPTION (provided by applicant): Alcohol misuse (AMU) inflicts high costs on individuals and society. Timely intervention can be effective in reducing the impact, but AMU is rarely identified and treated in practice. Although AMU afflicts young, healthy people, it also frequently occurs superimposed on psychosocial problems, which are also frequently not identified. The common thread is that physicians lack the time and resources for a complete assessment and for appropriately treating biopsychosocial and health behavioral issues that are discovered. A central tenet of psychometrics is that if you want to know what is going on with the patient, you must ask the patient-not a provider and not the chart. If you want to know about AMU, patients must be asked directly; providers will not know and paper questionnaires cannot be scaled into an effective solution. SOLUTION: Our work builds on an operational, Web-based, patient self-assessment system called CarePrep that allows patients to easily enter and track symptom, psychosocial, and QOL data over the Internet from home or clinic. APPROACH: (1) We will deploy CarePrep in a primary care clinic, addressing any policy and procedural issues and fitting the system into the pathway of care, with the goal of assessing patients before their clinic visit. Patient testing will be conducted to identify and resolve problems with use and to start data collection for the Aim 2 validation. (2) Working with alcohol and psychometric experts, we will extend and validate CarePrep to screen for and assess AMU in the context of patients' bio-psychosocial issues. We will build on established instruments like the AUDIT and on established domains and items, focusing on early identification and assessment of dependency and consequences from AMU. High priority is placed upon generating value in medical settings, so that the system gets used. Clinical relevance and construct validity will be assessed. We will assess feasibility and acceptance by providers and patients. IMPACT: (1) Initial development and validation of an online resource capable of identifying and assessing AMU in the context of relevant biopsychosocial issues. (2) A integrated intervention that embeds screening and a brief intervention for AMU into the pathway of routine medical care, creating value for providers and patients so that the system gets used. (3) The core of a consensus resource for research that turns routine clinical encounters into research opportunities and supports relevant, transparent investigation of AMU. PUBLIC HEALTH RELEVANCE: This work adapts a web-based, patient self-assessment system that is now in operation in clinic to identify and assess alcohol misuse in medical settings in the context of the patients' medical and psychosocial issues. Since medical physicians frequently do not have the time to assess and provide brief interventions and continuing care, the online system will be developed to operate as independently as possible to support care, informing the clinician of the patient's status and problems. We propose to develop the questions for the assessment and then to test their validity with patients and whether use is acceptable to patients and physicians. Long-range goals are to establish that this approach improves care for alcohol misuse.