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

描述（由申请人提供）：我是一名医生和早期职业翻译调查员，研究重点是确定将药物滥用治疗纳入一般医疗保健环境的有效方法。由于筛选药物滥用患者是耗时的临床医生的一部分，我建议研究，以解决病人自我管理的筛选的有效性。本研究的具体研究和培训目标围绕两个主要重点领域：行为研究方法（调查研究，定量分析，定性方法）和实施研究。这些领域中的每一个都由具有相应专业知识的经验丰富的导师锚定，并通过结合课程作业和定向阅读以及研究经验的教学指导进一步发展。在我的主要导师Marc Gourevitch，MD，MPH的赞助下，我的研究和培训计划利用了纽约大学Langone医学中心和贝尔维尤医院的临床和学术资源，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，其中一个主要障碍是缺乏一种简单的工具，可以准确有效地识别具有不健康物质使用行为的患者。被广泛接受和验证的“酒精，吸烟和物质参与筛选测试（ASSIST）对于典型的医疗访问来说太长了，结果大大利用不足。我将调整ASSIST，这是设计和验证管理作为一个面对面的采访，以音频引导的计算机辅助自我采访（ACASI），患者可以完成之前，他们的医疗访问。我计划分3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调整ACASI管理的ASSIST; 2）测试其相对于传统访谈者管理的ASSIST的有效性; 3）探索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。 公共卫生相关性：拟议的研究将作出宝贵的贡献，推进物质使用筛查纳入定期初级保健实践。这是朝着我的长期目标迈出的重要一步，即制定、实施和传播简单而有效的干预措施，提高医疗系统应对药物滥用和依赖的健康负担的能力。我的研究，指导和培训活动奠定了一系列研究的基础，这将定义我的职业生涯作为一个独立的调查员和医生领导者在改善物质使用者的健康。

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.