Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

描述（由申请人提供）：这是“青少年AOD使用筛查：初级保健提供者的研究”的更新。卫生系统尚未对青少年实施筛查、短暂干预和转诊治疗（SBIRT），尽管研究表明其有效性。基于先前的研究，确定了儿童初级保健（PC）中青少年AOD筛查的障碍，以及一项试点研究，该研究发现SBIRT是可行的，受到良好的接受，并促进了转诊和专科治疗的启动，目前的研究申请建议将大型管理医疗卫生系统Kaiser Permanente北加州医疗中心儿科诊所的初级保健医生（pps）随机分为三组：1)常规护理；2) pcp交付的SBIRT；3)由行为医学专家（BMS）提供的SBIRT。这项研究的目标是实现相比,效率和成本效益的SBIRT青少年在PC的三个研究武器。患者将完成基于证据的筛查和AOD评估措施，这些措施已嵌入健康计划的电子病历（EMR）中。将使用混合模型来比较12个月的实施结果（筛查和识别率，短暂干预，转诊到化学依赖治疗和治疗开始）和有效性（AOD使用和戒断的患者结果）。该模型解释了提供者内部患者之间的类内相关性。将审查与实施和患者结果相关的成本效益。通过与临床医生和管理人员的定性访谈，还将审查实施的障碍和促进因素以及可行性。这项研究具有重要意义，因为它探讨了必须解决的问题，以促进SBIRT的广泛适应。拟议的干预措施在目前的卫生改革环境中是非常可行的，因为联邦合格的保健中心和私人保健计划的资源和培训增加了。它创新地利用电子病历改变临床实践，系统地将AOD整合到PC中，并作为收集研究数据的平台。

DESCRIPTION (provided by applicant): This is a renewal of "Screening for Youth AOD Use: A Study of Primary Care Providers. Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiaion), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed intereventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.