Screening for Substance Use with Computer Assisted Self Interview in Primary Care

描述（由申请人提供）：我是一名内科医生和早期职业转化研究者，研究重点是确定将药物滥用治疗纳入一般医疗保健设置的有效方法。因为对病人进行药物滥用的筛查对临床医生来说是非常耗时的，所以我建议对病人自我进行筛查的有效性进行研究。本研究的具体研究和培训目标围绕两个主要关注领域进行整合：行为研究方法（调查研究、定量分析、定性方法）和实施研究。每一个领域都有一位经验丰富的导师，具有相应的专业知识，并通过结合课程作业、指导阅读和研究经验的教学指导进一步发展。在我的主要导师Marc Gourevitch（医学博士，公共卫生硕士）的赞助下，我的研究和培训计划利用了纽约大学langone医学中心和Bellevue医院的临床和学术资源，在那里药物滥用治疗和研究一直是一个长期的重点领域。我提出的研究探索了一种创新的方法来提高初级保健中物质使用筛查的比率，主要障碍是缺乏一种简短的工具，可以准确有效地识别患有不健康物质使用行为的患者。广泛接受和验证的“酒精，吸烟和物质介入筛查测试（ASSIST）对于典型的医疗访问来说太长了，因此大大没有得到充分利用。我将把ASSIST（设计和验证为面对面访谈的方式）改造成音频引导的计算机辅助自我访谈（ACASI），病人可以在就诊前完成。我计划分三个阶段进行一项混合方法研究，以1)在城市安全网初级保健诊所人群中适应ACASI管理的ASSIST；2)检验其相对于传统访谈者管理的ASSIST的效度；3)探讨医生对使用这些筛查结果来解决初级保健办公室物质使用问题的态度。

DESCRIPTION (provided by applicant): I am a physician and early career translational investigator, with a research focus on identifying effective approaches for integrating substance abuse treatment into general healthcare settings. Because screening patients for substance abuse is time consuming on the part of clinicians, I propose research to address the validity of patient self-administered screening. The specific research and training aims of this study are integrated around two primary areas of focus: behavioral research methods (survey research, quantitative analysis, qualitative methods) and implementation research. Each of these areas is anchored by an experienced mentor with corresponding expertise, and further developed through didactic instruction combining coursework and directed readings as well as research experience. Under the sponsorship of my primary mentor Marc Gourevitch, MD, MPH, my research and training plans utilize the clinical and academic resources of New York University-Langone Medical Center and Bellevue Hospital, where substance abuse treatment and research has been a longstanding area of emphasis. My proposed study explores an innovative approach to improving rates of substance use screening in primary care, a major impediment to which has been the lack of a brief instrument that can accurately and efficiently identify patients with unhealthy substance use behaviors. The widely accepted and validated "Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is too lengthy for the typical medical visit, and greatly under-utilized as a result. I will adapt the ASSIST, which was designed and validated to be administered as an in-person interview, to an audio guided computer-assisted self interview (ACASI) that patients can complete prior to their medical visit. I plan a mixed methods study in 3 phases to 1) adapt the ASSIST for ACASI administration in an urban safety- net primary care clinic population; 2) test its validity relative to the traditional interviewer-administered ASSIST; and 3) explore physician attitudes to using these screening results to address substance use in the primary care office. PUBLIC HEALTH RELEVANCE: The proposed study will make a valuable contribution to advancing the integration of substance use screening into regular primary care practice. This is an important step toward my long-term goal of developing, implementing, and disseminating simple but effective interventions that improve the capacity of medical systems to respond to the health burden of substance abuse and dependence. My research, mentorship and training activities lay the groundwork for a line of research that will define my career as an independent investigator and physician leader in improving the health of substance users.