Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery

描述（由申请人提供）：虽然在急诊室（ED）看到的患者中有很高比例存在风险或问题酒精使用，但很少有人接受筛查并接受旨在帮助他们减少或停止饮酒的简短干预（BI）等服务。执行主任通常不提供BI，这可能是由于可行性方面的挑战，如培训工作人员、监测忠诚度和维护系统以确保长期实施。已发现酒精BI在各种医疗保健环境中有效。然而，在艾德中使用它们的证据是混合的。迫切需要制定有效的策略，以筛选和优化提供酒精BI在这个快节奏和广泛使用的设置。现有的临床医生交付的BI策略需要修改，以便它们可以标准化，并以高保真度和对艾德工作人员时间和资源的最低要求进行管理。计算机提供的BI是解决在这种和其他医疗保健环境中提供干预的固有挑战的一种方法。这项研究将通过带音频的触摸屏平板电脑进行计算机化筛查，招募750名市中心艾德患者，这些患者在酒精使用风险或问题方面筛查呈阳性。年龄在18-60岁之间的参与者将被随机分配到以下三种情况中的一种：1）计算机提供的简短干预（C-BI; n=250）; 2）治疗师提供的简短干预（T-BI; n=250）;或3）加强常规护理（EUC; n=250）。所有参与者将收到有关社区资源的书面信息;符合酒精滥用/依赖标准的个人也将收到酒精治疗转诊。对于所有疾病，将在基线时进行分层随机分配[按性别;符合酒精使用障碍的标准-是/否]。本研究的目的是开发和完善有针对性的激励性简短干预措施，这些措施在结构上是平行的，但有不同的交付方式（计算机与治疗师）的风险或有问题的酒精使用的患者，并进行随机对照试验，比较这些BI方法的疗效（C-BI，T-BI，对照）对随后的饮酒和酒精后果的影响，包括酒精相关的损伤，精神和身体健康功能，以及3-，6-，和ED后12个月访视。对治疗师与计算机提供的BI（包括潜在的调节者和调解者）的有效性进行严格检查，将解决先前试验提出的关键限制，并将确定在该场所广泛实施简短酒精干预的最佳模式。由于艾德是进入医疗保健系统的重要门户，特别是对于市中心的患者，提供有效的酒精BI，强调关键的动机访谈组成部分，并尽量减少人力资源可能会产生重大的公共卫生影响。

DESCRIPTION (provided by applicant): Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or problem alcohol use, few are screened and receive services such as brief interventions (BI) designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious and effective in a variety of health care settings. However, the evidence for their use in the ED has been mixed. There is a pressing need to develop efficacious strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing clinician-delivered BI strategies need to be modified so that they can be standardized and administered with high fidelity and minimal demands on ED staff time and resources. Computer-delivered BIs are one method to address the challenges inherent in delivering interventions in this and other healthcare settings. The proposed study will use computerized screening via touch-screen computer tablets with audio to recruit 750 inner-city ED patients screening positive for at-risk or problem alcohol use. Participants age 18-60 will be randomized to one of three conditions: 1) Computer-delivered brief intervention (C-BI; n=250); 2) Therapist-delivered brief intervention (T-BI; n=250); or 3) Enhanced usual care (EUC; n=250). All participants will receive written information regarding community resources; individuals who meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals. Stratified random assignment [by gender; meeting criteria for an alcohol use disorder - yes/no] will take place at baseline for all conditions. The aims of the study are to develop and refine tailored motivational brief interventions that are parallel in structure but have varied delivery modalities (computer vs. therapist) for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled trial comparing the efficacy of these BI approaches (C-BI, T-BI, control) on subsequent alcohol consumption and alcohol consequences, including alcohol-related injury, mental and physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit. The rigorous examination of the efficacy of therapist- vs. computer- delivered BIs, including potential moderators and mediators, will address the key limitations raised by previous trials and will determine the optimal modality for wide implementation of brief alcohol interventions in this venue. Because the ED is such an important portal for entry into the medical care system, particularly for inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational interviewing components and minimize staff resources could have a major public health impact..