SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

描述（由申请人提供）：酒精，烟草和其他药物的使用在美国青少年中仍然非常普遍，对他们的福祉和公共健康构成威胁。临床试验和荟萃分析证据支持筛查，短暂干预和转诊治疗（SBIRT）对青少年药物滥用的有效性，SBIRT是美国儿科学会推荐的。尽管SBIRT得到了联邦的支持，但初级保健提供者在采用这种循证方法方面进展缓慢。因此，需要进行研究，以确定有效的方法来实施SBIRT的青少年，使这种方法可以带来规模，并实现其充分的公共卫生影响。指导普罗克特的实施研究的概念模型，拟议的研究是一个多地点，集群随机试验，比较两个主要战略的SBIRT交付在青少年医学。在通才策略中，初级保健提供者提供药物滥用的简短干预（BI）。在专家战略中，BI由行为健康顾问提供。将随机分配8个研究中心（由巴尔的摩的一家大型城市联邦合格卫生中心运营的初级保健诊所），使用全科或专科策略对青少年实施SBIRT。每个研究中心的工作人员将接受指定实施战略的培训，并在实施期间提供季度加强培训。在为期18个月的实施期内，将使用行政服务接触数据、提供者和患者调查以及定性访谈的互补组合评估实施成果，包括：渗透率、成本/成本效益、可接受性、及时性、忠诚度/依从性和患者满意度。在积极执行期结束时，所有培训和技术支助活动将停止12个月，以衡量相对的可持续性。具体目标是： (1)检查通才与专科医生实施策略在（i）BI渗透率方面的相对有效性，（ii）在有需要时转介专科药物滥用治疗;（2）厘定两项策略的（iii）成本及（iv）成本效益;和（3）比较两种战略的关键执行因素，包括（v）可接受性;（vi）及时性;（vii）忠诚/粘附;（viii）患者满意度;和（ix）可持续性。这项拟议中的研究是重要的，因为它将填补一个重大的差距，在科学知识的最佳SBIRT实施战略的时候，SBIRT是准备在医疗保健改革的规模。它是创新的，因为它将是青少年SBIRT的第一个实施研究，也是第一个使用实施科学概念框架进行简短干预的前瞻性试验之一。最后，该研究将包括新的成本数据，这些数据将为 在青少年保健中采用SBIRT。

DESCRIPTION (provided by applicant): Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Clinical trials and meta-analyses evidence supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse, and SBIRT is recommended by the American Academy of Pediatrics. Despite federal support of SBIRT, primary care providers have been slow to adopt this evidence-based approach. Thus, research is needed to determine effective ways to implement SBIRT for adolescents so that this approach can be brought to scale and achieve its full public health impact. Guided by Proctor's conceptual model of implementation research, the proposed study is a multi-site, cluster randomized trial to compare two principal strategies of SBIRT delivery within adolescent medicine. In the Generalist Strategy, the primary care provider delivers brief intervention (BI) fo substance misuse. In the Specialist Strategy, BIs are delivered by behavioral health counselors. The 8 study sites, primary care clinics operated by a large, urban Federally Qualified Health Center in Baltimore, will be randomly assigned to implement SBIRT for adolescents using either the Generalist or Specialist strategies. Staff at each site will be trained in the assigned implementation strategy, and quarterly booster trainings will be provided during the implementation period. Implementation outcomes, including: penetration, costs/cost- effectiveness, acceptability, timeliness, fidelity/adherence, and patient satisfaction will be assessed during the 18-month-long implementation period using a complementary combination of administrative service encounter data, provider and patient surveys, and qualitative interviews. At the end of the active implementation period, all training and technical support activities will cease for 12 months in order to measure relative sustainability. Specific Aims are: (1) to examine the relative effectiveness of the Generalist v. the Specialist implementation strategies in terms of penetration of (i) BI for those adolescents for whom it is indicated and (ii referral to specialty substance abuse treatment when indicated; (2) To determine the (iii) cost and (iv) cost-effectiveness of the two strategies; and (3) to compare the two strategies in terms of key implementation factors, including (v) acceptability; (vi) timeliness; (vii) fidelity/adherene; (viii) patient satisfaction; and (ix) sustainability. The proposed study is significant because it ill fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It is innovative because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for brief interventions. Finally, the study will include novel cost data that will provide guidance about the adoption of SBIRT in adolescent health care.