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

基于网络的干预措施减少丙型肝炎退伍军人的饮酒

• 批准号: 8396856
• 负责人: Keith N. Humphreys
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396856
• 关键词: Address; Adopted; Adoption; Aftercare; Alcohol consumption; Antiviral Agents; Antiviral Therapy; Behavioral; Budgets; Caring; Clinic; Clinic Visits; Clinical; Commit; Data; Development; Diffusion; Effectiveness; Eligibility Determination; Evaluation; Experimental Designs; Feedback; Fibrosis; Habits; Health; Health Services Accessibility; Health Status; Healthcare; Healthcare Systems; Heavy Drinking; Hepatitis C; Hepatitis C virus; Hybrids; Improve Access; Inpatients; Intervention; Interview; Intranet; Knowledge; Light; Link; Medical; Medical center; Mental Health; Mental Health Services; Methods; Online Systems; Outcome; Outpatients; Participant; Patients; Perception; Pharmacy facility; Population; Primary Health Care; Protocols documentation; Provider; Public Health; Randomized; Resources; San Francisco; Self-Administered; Services; Site; Site Visit; Substance Use Disorder; System; Technology; Time; Veterans; alcohol abuse therapy; alcohol misuse; alcohol related consequences; alcohol use disorder; base; brief alcohol intervention; care seeking; cost; design; drinking; evidence base; evidence based guidelines; follow-up; forging; health administration; health care service utilization; improved; innovation; interest; meetings; motivational enhancement therapy; operation; psychological distress; reduced alcohol use; response; satisfaction; scale up; treatment as usual

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.

描述（由申请人提供）： 多达 80% 的携带丙型肝炎病毒 (HCV) 的退伍军人都有有害饮酒行为。这是一项重大的健康挑战，因为即使少量和适量饮酒也会恶化丙肝病毒的病程和后果，并可能成为接受抗病毒治疗的障碍。作为回应，退伍军人管理局统一心理健康服务包已将 HCV 和其他门诊诊所作为优先事项，在两周内（但最好是在就诊当天）向所有参与有害饮酒的退伍军人提供循证心理健康服务。我们的 CREATE 合作伙伴、退伍军人管理局心理健康服务办公室、退伍军人管理局运营部 (10N) 和退伍军人管理局公共卫生办公室坚定致力于在整个退伍军人健康管理局 (VHA) 中实现这一标准。然而，在 HCV 诊所中满足这一要求的成本和组织挑战是巨大的，但可以通过使用自主技术来克服，从而最大限度地减少对稀缺员工时间的需求。 本研究的主要目的是实施和评估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卫生保健系统 (VAPAHCS) 和旧金山退伍军人事务部医疗中心 (SFVAMC) 寻求护理。这项研究将有三个目标：首先（目标 1），我们计划评估可能影响两个 VA HCV 诊所最初采用该干预措施的患者、提供者和系统因素。这些数据将导致制定一项协议，以便在我们的两个研究地点初步实施基于网络的 BAI。第二个目标将涉及获取患者和提供者对现有基于网络的 BAI（参见 www.bmi-aft.org，仅限 VA 内联网）的反馈，以帮助为该人群的重新设计提供信息。其次（目标 2），我们将在两家 HCV 诊所实施并检查基于网络的 BAI 的有效性，以减少 HCV 退伍军人在治疗后三个月和六个月的饮酒量。第三（目标 3），我们将进行预算影响分析，以估计基于网络的 BAI 的采用和传播的短期成本（1-3 年）以及研究参与者的医疗保健支出轨迹。 这项混合方法研究将利用定性和定量方法来实现其三个主要目标。为了实现目标 1，将使用定性访谈来收集数据，为基于网络的 BAI 的初步实施和重新版本提供信息，以供位于帕洛阿尔托和旧金山的两家 HCV 诊所使用。为了实现目标 2，我们将使用随机、混合（类型 1）设计，收集患者级别的临床结果数据和形成性评估数据，以检查基于网络的 BAI 的有效性。 “混合”设计还将形成性评估整合到实验设计中，以确定影响实施工作有效性的因素。形成性评估（例如现场访问、临床观察以及对工作人员和患者的访谈）将用于改善两个站点对基于网络的 BAI 的采用，并为我们的 CREATE 运营合作伙伴在全国范围内实施提供基于证据的指导。为了实现目标 3，我们将进行预算影响分析，以估计基于网络的 BAI 的采用和传播的短期成本（1-3 年）以及研究参与者的医疗保健支出轨迹。我们计划收集多种类型的利用数据，包括门诊、住院和药房利用数据，并使用 DSS 成本数据计算治疗前后 6 个月内每种类型的医疗保健利用所花费的总美元。