Partnerships to Reduce Disparities in Substance Use Screening and Treatment

背景：在新墨西哥州，拉美裔和美洲原住民在筛选和治疗有问题的酒精和阿片类药物使用方面存在显著的健康差异。尽管有对问题酒精使用和阿片类药物依赖进行初级保健的筛查和短暂干预的方法，但数据继续表明，这种战略没有得到充分利用。改善初级保健中酒精和阿片类药物服务的提供将需要对社区和初级保健背景的创新理解，在这种情况下 这些服务都是提供的。 目标和目的：这一生态、混合方法项目的具体目标是： 1)通过在以初级保健实践为基础的研究网络中进行三阶段混合方法研究，更全面地描述影响对问题酒精使用和阿片依赖进行循证筛查和治疗的复杂因素； 2)更充分地了解社区层面的因素和对酒精使用、阿片类药物依赖以及对初级保健中这些问题的筛查和治疗的接受程度；3)根据社区和初级保健提供者的反馈，创建灵活的模式，在不同的初级保健和社区环境中匹配酒精和阿片类药物筛查和干预方法；以及4)评估这些模型在加强初级保健中对问题酒精和阿片类药物使用的筛查和干预方面的可行性。 设计和方法：计划一项多方法、三阶段研究，使用调查、定性病例研究、访谈和观察数据进行多达12项初级保健临床评估，并在此基础上开发和实施先导性干预研究。这项研究将在以初级保健实践为基础的研究网络中进行，并将使用参与性方法来吸引社区行为健康和药物使用伙伴的参与。 结果：这项研究将产生数据，用于创建和测试新模式(S)干预初级保健诊所以加强酒精滥用和阿片依赖服务的可行性。与之前关于改变初级保健诊所以更多地关注问题酒精使用和阿片依赖问题的想法不同，这些创新的模式将纳入初级保健的情境性和复杂性。后续研究的目的将是在更广泛的范围内测试基于新模式(S)的干预措施的有效性，旨在减少拉美裔和美洲原住民之间的物质使用差异。

Background: Significant health disparities exist for Hispanics and Native Americans in screening and treatment for problem alcohol and opioid use in New Mexico. Despite the availability of methods for screening and brief intervention in primary care for problem alcohol use and opioid dependence, data continue to show that such strategies are underutilized. Improved alcohol and opioid services delivery in primary care will require innovative understandings of the community and primary care context in which these services are provided. Objectives and aims: The specific aims of this ecological, mixed method project are: 1) To more fully describe the complex factors influencing implementation of evidence-based screening and treatment for problem alcohol use and opioid dependence by conducting a three-phase mixed-method study in a primary care practice-based research network; 2) To more fully understand community level factors and perceptions of alcohol use, opioid dependence and the acceptance of screening and treatment for these problems in primary care; 3) Based upon Community and Primary Care Provider feedback, create flexible models for matching approaches to alcohol and opioid screening and intervention with different primary care and community settings; and 4) To assess the feasibility of these models in enhancing screening and intervention for problem alcohol and opioid use in primary care. Design and methods: A multi-method, three phase study is planned, using survey, qualitative case study, interview, and observational data to conduct up to 12 primary care clinic assessments from which a pilot intervention study will be developed and implemented. The study will be conducted in a primary care practice-based research network and will use a participatory approach to engage community behavioral health and substance use partners. Outcomes: This study will produce data that will be used to create and test the feasibility of new model(s) for intervening in primary care clinics to enhance alcohol abuse and opioid dependence services. In contrast to previous ideas about changing primary care clinic to increase attention to problem alcohol use and opioid dependency issues, these innovative models will incorporate the situational and complex nature of primary care. Subsequent research will aim to test the effectiveness of interventions based on the new model(s) on a broader scale aimed at reducing substance use disparities among Hispanics and Native Americans.