Northwest Pennsylvania Adolescent Alcohol Research Cooperative (Phase II)

描述(由申请人提供)：农村初级卫生保健提供者可以在识别、管理和转介未成年饮酒者方面发挥重要作用。这项申请建议继续实施一项计划，该计划已成功地让30名农村初级卫生保健提供者参与开发一个合作网络，以开展针对未成年人饮酒问题的研究。宾夕法尼亚州西北部青少年酒精研究合作社(NPAARC)包括来自匹兹堡青少年酒精研究中心、匹兹堡大学布拉德福德校区农村健康实践中心的成员，以及八个县农村地区的初级保健从业者。在第一阶段，为未成年饮酒者提供服务的农村医生参与了一项关于他们与酒精相关的临床做法和态度的调查。这些从业者中的一部分，以及青少年和父母，参加了焦点小组，探索促进和阻碍影响酒精相关筛查、短暂干预和转诊治疗的因素。我们开发了针对未成年饮酒者的计算机辅助决策支持(CADSUD)，评估部分在两个实践中对225多名青少年进行了测试，干预部分将很快在这些实践中实施。2009年将有另外两个实践项目加入进来，我们预计第一阶段将有四个实践项目和800名青少年参加CADSUD测试。在第二阶段，CADSUD项目将在另外六个项目中进行测试，共有1200名青少年参加。在这些青少年(12-20岁)就诊之前，将通过CADSUD对他们进行酒精使用和相关障碍的评估。为了确定CADSUD的影响，将在两个实施阶段比较从业者和青少年的结果：(1)仅评估控制条件和(2)全面实施条件，包括PCP反馈、评估解释、干预建议和为患者提供的量身定制的书面材料。评估的结果将包括从业者评估和转诊模式、患者对转诊建议的遵守情况，以及通过2个月和12个月的随访评估确定的青少年酒精使用情况。将鼓励PCP在社区场所使用CADSUD，并将获得相关的技术支持。因此，NPAARC将开发、测试和实施一种方法，通过初级保健实践来解决农村未成年人饮酒问题。 公共卫生相关性：NPAARC将为从业者提供临床工具，同时作为干预研究的平台。CADSUD通过提供计算机辅助的访问前评估、适合发展的基于网络的访问后干预和转介建议，解决了初级保健筛查和简短干预的障碍。CADSUD需要有限的从业者培训，如果被证明有效，可以很容易地传播。

DESCRIPTION (provided by applicant): Rural primary health care providers can play a vital role in the identification, management, and referral of underage drinkers. This application proposes to continue a program that has successfully engaged 30 rural primary health care providers in the development of a collaborative network for conducting research addressing underage drinking. The Northwest Pennsylvania Adolescent Alcohol Research Cooperative (NPAARC) includes members from the Pittsburgh Adolescent Alcohol Research Center, the Center for Rural Health Practice at the University of Pittsburgh - Bradford campus and primary care practitioners in a rural eight county area. In Phase I, rural practitioners serving underage drinkers participated in a survey on their alcohol-related clinical practices and attitudes. A subset of these practitioners, along with teens and parents, participated in focus groups that explored facilitating and hindering factors influencing alcohol-related screening, brief intervention and referral for treatment. Our Computer Assisted Decision Support for Underage Drinkers (CADSUD) was developed, the assessment component was tested with over 225 adolescents in two practices, and the intervention component will soon be implemented in these practices. With two additional practices scheduled to become involved in 2009, we anticipate that four practices and 800 adolescents will have participated in CADSUD testing during Phase I. in Phase II, CADSUD will be tested in six additional practices with 1200 adolescents. Before their health care visit, these adolescents (12-20 years old) will be assessed via CADSUD on alcohol use and related disorders. To determine the influence of CADSUD, practitioner and adolescent outcomes will be compared during two implementation stages: (1) an assessment only control condition and (2) a full implementation condition including PCP feedback, interpretation of assessments, intervention suggestions, and tailored written materials provided for the patient. Outcomes assessed will include practitioner assessment and referral patterns, patient adherence to referral recommendations, and adolescent alcohol use determined by 2-month and 12-month follow-up assessments. PCPs will be encouraged to utilize CADSUD in community venues and will be provided with related technical support. NPAARC will thus develop, test, and implement a method to address rural underage drinking through primary care practices. PUBLIC HEALTH RELEVANCE: NPAARC will provide clinical tools to practitioners while serving as the platform for intervention research. CADSUD addresses barriers to primary care screening and brief intervention by providing a computer- assisted pre-visit assessment, developmentally appropriate web-based post-visit interventions, and referral suggestions. CADSUD requires limited practitioner training and, if proven effective, could be readily disseminated.