Enhancing Early-Phase Care for Primary Care Patients with Unhealthy Substance Use

加强对使用不健康药物的初级保健患者的早期护理

基本信息

批准号：
8300641
负责人：
ELIZABETH L MERRICK
金额：
$ 19.66万
依托单位：
BRANDEIS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8300641
关键词：
Address Adopted Alcohol consumption Alcohol or Other Drugs use Area Caring Complex Control Groups Counseling Data Diagnosis Drug usage Early treatment Electronic Health Record Environment Face Gifts Health Health system Healthcare Incentives Integrated Delivery Systems Interview Light Link Massachusetts Measures Medical Medical center Monitor Motivation Outcome Outpatients Patient Care Patient Participation Patients Pattern Patterns of Care Performance Phase Pilot Projects Play Preclinical Drug Evaluation Primary Health Care Prize Probability Process Provider Quality of Care Randomized Research Risk Role Screening Result Screening procedure Services Stigmata Substance Use Disorder Surveys System Testing Time Training Veterans Visit alcohol screening base cohort contingency management design experience financial incentive follow-up health administration improved indexing innovation insight medical specialties novel primary care setting response screening, brief intervention, referral, and treatment skills social stigma

项目摘要

DESCRIPTION (provided by applicant): Primary care settings offer an excellent opportunity to identify and address unhealthy substance use ranging from at-risk use to substance use disorders (SUD). Practitioners can help with problem identification, brief counseling, follow-up/monitoring, motivating patients, and linkage to specialty care. However, opportunities are often missed. Even when SUD are identified, there are low rates of treatment initiation (1 SUD service in any setting within 14 days after diagnosis) and engagement (2 services in 30 days after initiation) as defined in the widely-used HEDIS performance measures. Both patients and providers play a role. For example, providers may lack skills, time or motivation; patients may face stigma, denial or access barriers. The Veterans Health Administration (VA), like other systems, faces a challenge in this area. About 7% of all veterans and up to 25% of younger cohorts have SUD. Many more have at-risk use. Among VA patients identified with SUD in an outpatient medical (non-behavioral health) setting only 9% initiate care, and 31% of those engage in care. Yet these are recognized as important parameters of early-phase care and engagement has been linked to better outcomes. The aims of this exploratory study in a large VA medical center are to: 1) Examine screening patterns and early care trajectories including provider response and service use following a) positive drug or alcohol screening in primary care, and b) SUD diagnosis; identify associated patient and provider factors. 2) Conduct pilot testing of patient incentives to enhance treatment initiation and engagement for primary care patients identified with SUD in primary care. 3) Assess patient and provider perspectives on early-phase care and treatment incentives. The study environment includes electronic health records, SBIRT training, and a brief drug screen added to well-adopted annual alcohol screening. In Aim 1, we analyze screening patterns and early care trajectories. In Aim 2, we pilot test contingency management-based incentives for early treatment participation for primary care patients with SUD (n=120 patients randomly assigned to incentives or control). We examine utilization and substance use outcomes. "Prize-based" financial incentives feature higher probability for low-value prizes. In Aim 3, we interview patients and providers on screening, early-phase care challenges, and incentives. This innovative study will shed light on early care patterns for patients identified in primary care with unhealthy substance use, making a unique contribution through analysis of linked screening, provider response and utilization data. It will yield preliminary evidence on how patient incentives may enhance treatment participation (untested in primary care). It will tap patient and provider views on early-phase car and incentives. Results will inform efforts to improve care as well as design of full-scale trials (e.g. comparing different levels of incentives). Thus, the study represents a novel line of research with far-reaching potential to improve quality of care. PUBLIC HEALTH RELEVANCE: Primary care offers an excellent opportunity to identify and intervene in unhealthy substance use but currently many opportunities are missed. This exploratory study will result in a better understanding of screening and early-phase care and how patient incentives may be useful in increasing treatment participation. Ultimately this will contribute to improving care for primary care patients with unhealthy substance use.

描述（由申请人提供）：初级保健设置提供了一个绝佳的机会，可以识别和解决不健康的物质使用，从处于风险使用到药物使用障碍（SUD）不等。从业人员可以帮助解决问题，简要咨询，随访/监测，激励患者以及与专业护理的联系。但是，通常会错过机会。即使确定了SUD，在诊断后的14天内在14天内的任何环境中有1次SUD服务）和广泛使用的HEDIS性能指标中定义的参与度（在启动后30天内提供2次服务）。患者和提供者都起着作用。例如，提供者可能缺乏技能，时间或动力；患者可能会面临污名，否认或进入障碍。像其他系统一样，退伍军人卫生管理局（VA）在这一领域面临挑战。所有退伍军人中约有7％和多达25％的年轻同伙患有SUD。更多的人有危险的使用。在门诊医疗（非行为健康）中发现SUD的VA患者中，只有9％的患者可以启动护理，其中31％的人从事护理。然而，这些被认为是早期护理和参与度的重要参数与更好的结果有关。这项探索性研究在大型VA医疗中心的目的是：1）检查筛查模式和早期护理轨迹，包括提供者的反应和服务使用后a）a）在a）a）在基层医疗中进行阳性药物或酒精筛查，b）SUD诊断；确定相关的患者和提供者因素。 2）对患者激励措施进行试点测试，以增强初级保健中SUD患者的治疗启动和参与度。 3）评估患者和提供者对早期护理和治疗激励措施的看法。研究环境包括电子健康记录，SBIRT培训和简短的药物筛查，并添加到良好的年度酒精筛查中。在AIM 1中，我们分析筛查模式和早期护理轨迹。在AIM 2中，我们为SUD患者的初级保健患者进行了基于基于管理人员的激励措施（n = 120名随机分配给激励措施或对照的患者）。我们检查利用和物质使用结果。 “基于奖品”的经济激励措施具有低价值奖品的可能性更高。在AIM 3中，我们在筛查，早期护理挑战和激励措施方面采访了患者和提供者。这项创新的研究将揭示出不健康的药物使用情况下在初级保健中确定的患者的早期护理模式，从而通过分析链接筛查，提供者响应和利用数据来做出独特的贡献。它将产生有关患者激励措施如何增强治疗参与的初步证据（未经初级保健中未经测试）。它将在早期汽车和激励措施上发挥患者和提供者的看法。结果将为改善护理以及设计全尺度试验的设计提供帮助（例如，比较不同级别的激励措施）。因此，该研究代表了一项新的研究线，具有改善护理质量的深远潜力。公共卫生相关性：初级保健提供了一个绝佳的机会来识别和干预不健康的药物使用情况，但目前错过了许多机会。这项探索性研究将使人们更好地了解筛查和早期治疗，以及患者激励措施如何在增加治疗参与方面有用。最终，这将有助于改善使用不健康药物使用的初级保健患者的护理。