Web-based Biopsychosocial Assessment and Intervention for Alcohol Misuse

描述（由申请人提供）：酒精滥用（AMU）给个人和社会带来了高昂的成本。及时干预可以有效减少影响，但在实践中很少发现和治疗AMU。虽然AMU折磨的是健康的年轻人，但它也经常与社会心理问题叠加在一起，而社会心理问题往往也没有被发现。常见的思路是，医生缺乏时间和资源来进行全面的评估，并适当地治疗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，如果你想知道病人发生了什么，你必须问病人——而不是医生或图表。如果你想了解AMU，必须直接询问患者；供应商不会知道，并且纸质问卷不能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、基于网络的、名为CarePrep的患者自我评估系统的基础上，该系统允许患者在家中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，并将该系统纳入护理途径，目标是在患者就诊前对其进行评估。将进行患者试验，以识别和解决使用中的问题，并开始收集Aim 2验证的数据。(2)与酒精和心理测量专家合作，我们将扩展和验证CarePrep在患者生物社会心理问题的背景下筛查和评估AMU。我们将以审计等已建立的工具以及已建立的领域和项目为基础，重点是早期识别和评估AMU的依赖性和后果。高度优先考虑在医疗环境中创造价值，以便系统得到使用。临床相关性和结构效度将被评估。我们将评估提供者和患者的可行性和接受程度。影响：(1)初步开发和验证能够在相关生物心理社会问题背景下识别和评估AMU的在线资源。(2)整合干预，将AMU的筛查和短暂干预嵌入到常规医疗护理的路径中，为提供者和患者创造价值，使系统被使用。(3)研究共识资源的核心，将常规临床接触转化为研究机会，并支持相关的、透明的AMU研究。

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.