Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery

优化急诊室的酒精简短干预措施：计算机与临床医生交付

• 批准号: 8497555
• 负责人: Frederic C Blow
• 金额: $ 62.99万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-20 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8497555
• 关键词: AIDS prevention; Accident and Emergency department; Address; Adoption; African American; Age; Alcohol abuse; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Back; Caring; Clinical; Code; Communities; Computers; DSM-IV; Data; Dependence; Detection; Development; Diagnosis; Effectiveness; Elements; Enrollment; Ensure; Equilibrium; Ethnic Origin; Exercise; Feedback; Frequencies; Gender; Goals; HIV risk; Habits; Health; Health Personnel; Healthcare; Individual; Injury; Inpatients; Intervention; Intervention Studies; Intervention Trial; Location; Mediation; Mediator of activation protein; Medical; Medicare/Medicaid; Meta-Analysis; Methods; Modality; Modeling; Monitor; Motivation; Negative Finding; Outcome; Participant; Patients; Pattern; Primary Health Care; Psyche structure; Public Health; Race; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Regulation; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Sampling Studies; Self Efficacy; Services; Severities; Site; Structure; Subgroup; System; Tablets; Technology; Testing; Time; Training; Translating; Trauma; United States; Visit; Writing; alcohol abuse therapy; alcohol consequences; alcohol misuse; alcohol related consequences; alcohol related problem; alcohol screening and brief intervention; alcohol use disorder; base; brief alcohol intervention; brief intervention; brief motivational intervention; care systems; clinical practice; comparative efficacy; computer generated; computerized; design; drinking; evidence base; experience; improved; inner city; innovation; intervention effect; laptop; longitudinal design; low socioeconomic status; meetings; motivational enhancement therapy; physical conditioning; prevent; programs; reduced alcohol use; research study; screening; screening, brief intervention, referral, and treatment; sex; skills; substance abuse treatment; technological innovation; therapy design; touchscreen; trauma centers; treatment as usual; trial comparing; underage drinker

DESCRIPTION (provided by applicant): Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or problem alcohol use, few are screened and receive services such as brief interventions (BI) designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious and effective in a variety of health care settings. However, the evidence for their use in the ED has been mixed. There is a pressing need to develop efficacious strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing clinician-delivered BI strategies need to be modified so that they can be standardized and administered with high fidelity and minimal demands on ED staff time and resources. Computer-delivered BIs are one method to address the challenges inherent in delivering interventions in this and other healthcare settings. The proposed study will use computerized screening via touch-screen computer tablets with audio to recruit 750 inner-city ED patients screening positive for at-risk or problem alcohol use. Participants age 18-60 will be randomized to one of three conditions: 1) Computer-delivered brief intervention (C-BI; n=250); 2) Therapist-delivered brief intervention (T-BI; n=250); or 3) Enhanced usual care (EUC; n=250). All participants will receive written information regarding community resources; individuals who meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals. Stratified random assignment [by gender; meeting criteria for an alcohol use disorder - yes/no] will take place at baseline for all conditions. The aims of the study are to develop and refine tailored motivational brief interventions that are parallel in structure but have varied delivery modalities (computer vs. therapist) for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled trial comparing the efficacy of these BI approaches (C-BI, T-BI, control) on subsequent alcohol consumption and alcohol consequences, including alcohol-related injury, mental and physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit. The rigorous examination of the efficacy of therapist- vs. computer- delivered BIs, including potential moderators and mediators, will address the key limitations raised by previous trials and will determine the optimal modality for wide implementation of brief alcohol interventions in this venue. Because the ED is such an important portal for entry into the medical care system, particularly for inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational interviewing components and minimize staff resources could have a major public health impact..

描述(由申请人提供)：尽管在急诊科就诊的患者中有很高比例存在饮酒风险或问题，但很少有患者经过筛查并接受旨在帮助他们减少或戒酒的短暂干预(BI)等服务。EDS通常不提供国际清算银行，这可能是因为可行性方面的挑战，如培训工作人员、监测忠诚度和维持一个确保长期实施的系统。酒精BIS已被发现在各种医疗保健环境中是有效的和有效的。然而，教育署使用这类药物的证据却参差不齐。在这种快节奏和广泛使用的环境中，迫切需要制定有效的策略来筛选和最佳地提供酒精BIS。现有的临床医生提供的BI策略需要修改，以便可以标准化和高保真地管理，并最大限度地减少对急诊室工作人员的时间和资源的要求。计算机提供的BIS是解决在这种和其他医疗保健环境中提供干预措施所固有的挑战的一种方法。这项拟议的研究将通过带有音频的触摸屏电脑平板电脑使用计算机筛查来招募750名市中心的ED患者，筛查出有危险或有问题的饮酒阳性。18-60岁的参与者将被随机分为三种情况之一：1)计算机提供的短暂干预(C-BI；n=250)；2)治疗师提供的短暂干预(T-BI；n=250)；或3)加强日常护理(EUC；n=250)。所有参与者将收到关于社区资源的书面信息；符合酒精滥用/依赖标准的个人也将获得酒精治疗转介。分层随机分配[按性别；符合酒精使用障碍的标准--是/否]将在所有情况下在基线上进行。本研究的目的是为有酒精使用风险或有问题的患者制定和完善量身定做的激励性简短干预措施，这些干预措施在结构上是平行的，但具有不同的提供方式(计算机和治疗师)，并进行一项随机对照试验，比较这些BI方法(C-BI、T-BI、对照)在ED就诊后3、6和12个月对随后的酒精消费和酒精后果的疗效，包括与酒精相关的损害、心理和身体健康功能以及艾滋病毒危险行为。对治疗师与计算机提供的BIS有效性的严格检查，包括潜在的主持人和调解人，将解决先前试验提出的关键限制，并将确定在该场所广泛实施短暂酒精干预的最佳方式。由于急诊室是进入医疗保健系统的重要门户，特别是对市中心的患者来说，提供有效的酒精BIS强调关键的激励性访谈组成部分并将工作人员资源降至最低，可能会对公共卫生产生重大影响。