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未成年饮酒者的识别，管理和转诊方面发挥重要作用。本申请建议继续实施一项计划，该计划已成功地使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。西北宾夕法尼亚州青少年酒精研究合作组织（NPAARC）包括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和农村八县地区的初级保健医生的成员。在第一阶段，为未成年饮酒者提供服务的乡村医生参加了一项关于他们与酒精有关的临床实践和态度的调查。这些从业者的一个子集，沿着青少年和家长，参加了焦点小组，探讨促进和阻碍因素影响酒精相关的筛查，简短的干预和转诊治疗。我们的计算机辅助决策支持未成年饮酒者（CADSUD）的开发，评估组件进行了测试，超过225名青少年在两个做法，和干预组件将很快在这些做法中实施。随着2009年计划参与的另外两个实践，我们预计在第一阶段将有四个实践和800名青少年参加CADSUD测试。在第二阶段，CADSUD将在另外六个实践中对1 200名青少年进行测试。在他们的医疗保健访问之前，这些青少年（12-20岁）将通过CADSUD对酒精使用和相关疾病进行评估。为了确定CADSUD的影响，将在两个实施阶段对从业者和青少年的结果进行比较：（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定制书面材料。评估的结果将包括医生评估和转诊模式，患者遵守转诊建议，以及通过2个月和12个月的随访评估确定的青少年饮酒情况。将鼓励初级专业人员在社区场所利用南美洲发展合作中心，并向其提供相关的技术支持。因此，NPAARC将制定、测试和实施一种方法，通过初级保健做法解决农村未成年人饮酒问题。 公共卫生相关性：NPAARC将为从业人员提供临床工具，同时作为干预研究的平台。CADSUD通过提供计算机辅助的访视前评估、适合发展的基于网络的访视后干预和转诊建议，解决了初级保健筛查和简短干预的障碍。CADSUD需要有限的从业人员培训，如果证明有效，可以随时传播。

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.