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Preventing Drug Use in Low Income Clinic Populations

预防低收入诊所人群吸毒

基本信息

批准号：
8271935
负责人：
Lillian Gelberg
金额：
$ 3.27万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8271935
关键词：
Absenteeism Abstinence Address Adult Age Alcohol abuse Alcohol or Other Drugs use Alcohols Amphetamines Area Behavior Behavioral Brain Cannabis Caring Clinic Cocaine Community Health Centers Computer Assisted Computers Consent Control Groups Coronary Arteriosclerosis Counseling County Crime Dependence Development Drug Addiction Drug abuse Drug usage Early Diagnosis Eating Eligibility Determination Goals HIV Health Health Educators Health Policy Health Promotion Health behavior Health education Heroin Individual Informed Consent Inpatients Intervention Intervention Trial Legal Los Angeles Low income Measures Methods Misinformation Mission Modeling Occupations Pathway interactions Patient Self-Report Patients Pharmaceutical Preparations Physical activity Physicians Physiological Policy Maker Population Population Heterogeneity Preclinical Drug Evaluation Prevention Prevention Research Primary Care Physician Primary Health Care Process Protocols documentation Public Health Randomized Randomized Controlled Trials Recording of previous events Recruitment Activity Reporting Risk Risk Assessment Risk Behaviors Sample Size Sampling Screening procedure Seat Belts Single-Blind Study Site Social support Substance abuse problem System Technology Telephone Testing Time Tobacco Unemployment Visit addiction base behavior change brief intervention cigarette smoking computerized design disability drug abuse prevention drug of abuse follow-up health care service utilization health related quality of life meetings patient population prevent primary care setting programs psychologic safety net social socioeconomics standard care theories vehicular accident

项目摘要

DESCRIPTION (provided by applicant): The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing `at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at 2 safety net clinics in Los Angeles County. For this small trial, we will sample patients with `at risk' use of stimulants (cocaine or amphetamines), the most commonly used serious drugs among patients at our clinic sites. "At risk" stimulant use is defined in this study as current use (past 90 days) of stimulants measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 8,000 patients will be approached for screening to yield a 12-month effective sample size of 200 eligible patients per condition (1) an intervention condition or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting stimulants use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting stimulant use and cautioning against use of other `at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician, which will be followed by two post-visit telephone health education sessions that will be of equal duration as the intervention sessions but will address healthy eating, physical activity, and seat belt use. Follow- up assessments will be conducted at 6 and 12 months post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone stimulant-use health education program could become a model for health promotion activities. that would be expanded to all `at risk' substance use and shared between community health centers. PUBLIC HEALTH RELEVANCE: The proposed study will address the critical need to reduce illegal drug use, in particular stimulant use, and the occurrence of drug-related harm in low-income racially diverse patient populations at urban primary care safety-net clinics. At risk for accelerated trajectories to drug dependence once drug use begins, low-income racially diverse populations pose particular concern for public health policy makers and drug-use prevention efforts. The study will be the first of its kind to standardize drug screening and physician brief intervention among racially diverse "at risk" stimulant users, that is casual or frequent use without the physiological or psychological manifestations of dependence, and it may effectively interrupt their pathway to dependence.

描述（由申请人提供）：戒烟药物干预试验 (QUIT) 将是美国第一个随机对照试验，旨在检测初级保健临床医生在洛杉矶县 2 个安全网诊所提供的简短干预方案对减少低收入成年患者（18 岁及以上）的“高风险”药物使用和药物相关伤害的效果。在这项小型试验中，我们将对使用兴奋剂（可卡因或安非他明）“有风险”的患者进行抽样，兴奋剂是我们诊所患者中最常用的严重药物。本研究将兴奋剂使用“有风险”定义为目前（过去 90 天）使用兴奋剂的情况，根据世界卫生组织酒精物质参与筛查测试 (ASSIST) 自我报告的总分为 4 至 26 分。我们将对总共 8,000 名患者进行筛查，以产生每种病症 200 名合格患者的 12 个月有效样本量（1）干预病症或（2）涉及照常护理的对照病症。在干预条件下，临床医生将在给出关于戒除兴奋剂的非常简短（少于 5 分钟）的建议后，在就诊后 2 周和 6 周举行两次药物健康教育课程，内容涉及戒除兴奋剂的使用，并警告不要使用其他“有风险”的物质使用，例如酒精和烟草。分配到控制条件的患者将在临床医生的基线访视时接受标准的药物使用护理，随后将进行两次访视后电话健康教育课程，其持续时间与干预课程相同，但将讨论健康饮食、身体活动和安全带的使用。随访评估将在随机分组后 6 个月和 12 个月进行。 QUIT 项目的框架是社会行动理论，简短的干预方案基于 NIDA 的预防研究原则以及 5A 方法在临床环境中协助患者行为改变（询问、建议、评估、协助、安排）的效用。如果发现这种临床医生和电话兴奋剂使用健康教育计划在社区卫生中心有效，则可以成为健康促进活动的典范。这将扩大到所有“有风险”的药物使用，并在社区卫生中心之间共享。公共卫生相关性：拟议的研究将解决减少非法药物使用的迫切需要，特别是兴奋剂的使用，以及城市初级保健安全网诊所的低收入种族多样化患者群体中与药物相关的伤害的发生。一旦开始吸毒，低收入的种族多样化人群就面临着加速药物依赖的风险，这引起了公共卫生政策制定者和吸毒预防工作的特别关注。该研究将是同类研究中第一个对不同种族的“高危”兴奋剂使用者进行标准化药物筛选和医生简短干预的研究，即随意或频繁使用而没有依赖性的生理或心理表现，并且可能有效地中断他们的依赖性途径。