Web-based Intervention to Reduce Alcohol Use in Veterans with Hepatitis C

描述（由申请人提供）： 多达80%的丙型肝炎病毒（HCV）退伍军人从事有害饮酒。这是一个重大的健康挑战，因为即使是轻度和中度饮酒也会恶化HCV的病程和后果，并可能成为接受抗病毒治疗的障碍。作为回应，VA统一心理健康服务包已将HCV和其他门诊诊所在两周内（但最好是与诊所就诊同一天）为所有参与有害饮酒的退伍军人提供循证心理健康服务作为优先事项。我们的CREATE合作伙伴，心理健康服务的VA办公室，VA业务（10 N）和公共卫生的VA办公室，都坚定地致力于实现这一标准在整个退伍军人健康管理局（VHA）。然而，在HCV诊所满足这一任务的成本和组织挑战是巨大的，但可以通过使用自我指导的技术，最大限度地减少对稀缺的工作人员时间的需求来克服。 本研究的主要目的是实施和评估一种基于网络的简短酒精干预（BAI），用于治疗患有HCV的退伍军人，并在两个VA HCV诊所-退伍军人事务部帕洛阿尔托医疗保健系统（VAPAHCS）和旧金山弗朗西斯科退伍军人事务医疗中心（SFVAMC）寻求护理。本研究将有三个目标：第一（目标1），我们计划评估患者，供应商和系统因素，可能会影响最初采用这种干预在两个VA HCV诊所。这些数据将导致在我们的两个研究中心初步实施基于网络的BAI的协议的发展。第二个目标是获得患者和提供者对现有基于网络的BAI的反馈（见www.bmi-aft.org，仅限VA内联网），以帮助为该人群的重新设计提供信息。第二（目标2），我们将在两个HCV诊所实施并检查基于网络的BAI的有效性，以减少治疗后三个月和六个月的HCV退伍军人的饮酒量。第三（目标3），我们将进行预算影响分析，以估计采用和传播基于网络的BAI的短期成本（1-3年）以及研究参与者的医疗保健支出轨迹。 这项混合方法的研究将利用定性和定量方法来实现其三个主要目标。为了解决目标1，定性访谈将被用来收集数据，这将通知在位于帕洛阿尔托和旧金山弗朗西斯科的两个HCV诊所使用的基于网络的BAI的初始实施和重新版本。为了实现目标2，我们将使用随机混合（1型）设计，收集患者水平的临床结局数据和形成性评价数据，以检查基于网络的BAI的有效性。“混合”设计还将形成性评价纳入实验设计，以确定影响执行工作成效的因素。形成性评价（例如，现场访问、临床观察以及与工作人员和患者的访谈）将用于改善基于网络的BAI在两个站点的采用，并为我们的CREATE业务合作伙伴提供基于证据的指导，以便在全国范围内实施。为了实现目标3，我们将进行预算影响分析，以估计采用和推广基于网络的BAI的短期成本（1-3年）以及研究参与者的医疗保健支出轨迹。我们计划收集几种类型的利用率数据，包括门诊、住院和药房利用率，并使用DSS成本数据计算治疗前后6个月每种类型的医疗保健利用率的总支出。

DESCRIPTION (provided by applicant): As many as 80% of Veterans with the hepatitis C virus (HCV) engage in harmful drinking. This is a major health challenge given that even light and moderate alcohol consumption can worsen the course and consequences of HCV and can be a barrier to receiving antiviral therapy. In response, the VA Uniform Mental Health Services Package has made it a priority that HCV and other ambulatory clinics provide evidence-based mental health services to all Veterans engaging in harmful drinking within two week (but preferably the same day as the clinic visit). Our CREATE partners, the VA Office of Mental Health Services, VA Operations (10N), and the VA Office of Public Health, are strongly committed to achieving this standard throughout the Veterans Health Administration (VHA). However, the cost and organizational challenges to meeting this mandate in HCV clinics are enormous, but may be surmountable through the use of self-directed technology that minimizes demands on scarce staff time. The primary objective of this study is to implement and evaluate a web-based brief alcohol intervention (BAI) for treating Veterans with HCV and seeking care at two VA HCV clinics - Veterans Affairs Palo Alto Health Care System (VAPAHCS) and San Francisco Veterans Affairs Medical Center (SFVAMC). This study will have three aims: First (Aim 1), we plan to assess patient, provider, and system factors that may impact the initial adoption of this intervention in two VA HCV clinics. These data will result in the development of a protocol for the initial implementation of the web-based BAI at our two study sites. A secondary aim will involve obtaining patient and provider feedback on an existing web-based BAI (see www.bmi-aft.org, VA Intranet Only) to help inform its redesign for use with this population. Second (Aim 2), we will implement and examine the effectiveness of a web-based BAI in two HCV clinics to reduce alcohol consumption in Veterans with HCV at three- and six-months post-treatment. Third (Aim 3), we will conduct a budget impact analysis to estimate the short-term costs (1-3 years) of adoption and diffusion of the web-based BAI and the trajectory of health care spending for study participants. This mixed-methods study will utilize qualitative and quantitative methods to achieve its three primary aims. To address aim 1, qualitative interviews will be used to collect data that will inform the initial implementation and re-versioning of a web-based BAI for use in two HCV clinics located at the Palo Alto and San Francisco. To address aim 2, we will use a randomized, hybrid (type 1) design with patient level clinical outcome data and formative evaluation data collected to examine the effectiveness of the web-based BAI. "Hybrid" designs also integrate formative evaluation into experimental designs to identify factors that impact the effectiveness of implementation efforts. Formative evaluation (e.g., site visits, clinic observatio, and interviews with staff and patients) will be used to improve the adoption of the web-based BAI at both sites and to provide evidence-based guidance to our CREATE operational partners for nationwide implementation. To address aim 3, we will conduct a budget impact analysis to estimate the short-term costs (1-3 years) of adoption and diffusion of the web-based BAI and the trajectory of health care spending for study participants. We plan to collect several types of utilization data, including outpatient, inpatient, and pharmacy utilization, and calculate total dollars spent for each type of health care utilization for the 6 months before and after treatment using DSS cost data.