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

描述(由申请人提供)： 携带丙型肝炎病毒的退伍军人中，多达80%的人饮酒有害。这是一个重大的健康挑战，因为即使是轻微和适度的饮酒也会恶化丙型肝炎病毒的过程和后果，并可能成为接受抗病毒治疗的障碍。作为回应，退伍军人事务部统一精神卫生服务一揽子计划将丙型肝炎病毒和其他非卧床诊所列为优先事项，在两周内(但最好是与诊所就诊的同一天)向所有从事有害饮酒的退伍军人提供循证的精神卫生服务。我们的Create合作伙伴，退伍军人精神卫生服务办公室、退伍军人事务部(10n)和退伍军人健康办公室公共卫生办公室，坚定地致力于在整个退伍军人健康管理局(VHA)实现这一标准。然而，在丙型肝炎诊所满足这一任务的成本和组织挑战是巨大的，但通过使用自我指导的技术，将对稀缺的工作人员时间的需求降至最低，可能是可以克服的。这项研究的主要目标是实施和评估基于网络的短暂酒精干预(BAI)，用于治疗患有丙型肝炎的退伍军人，并在退伍军人事务部帕洛阿尔托医疗保健系统(VAPAHCS)和旧金山退伍军人事务医疗中心(SFVAMC)这两家退伍军人事务丙型肝炎诊所寻求治疗。这项研究将有三个目标：首先(目标1)，我们计划评估患者、提供者和系统因素，这些因素可能会影响这种干预措施在两个VA丙型肝炎诊所的初步采用。这些数据将导致在我们的两个研究地点制定初步实施基于网络的BAI的协议。第二个目标将涉及获得患者和提供者对现有基于网络的BAI的反馈(仅见www.bmi-aft.org，VA内联网)，以帮助为其重新设计提供信息，以供这一人群使用。其次(目标2)，我们将在两家丙型肝炎诊所实施和检验基于网络的BAI的有效性，以减少丙型肝炎退伍军人在治疗后三个月和六个月的酒精消耗量。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支出轨迹。这项混合方法研究将利用定性和定量的方法来实现其三个主要目标。为实现目标1，将利用定性访谈收集数据，以便为初步实施和更新基于网络的BAI提供信息，以供位于帕洛阿尔托和旧金山的两个丙型肝炎病毒诊所使用。为了解决目标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纳入实验设计，以确定影响执行工作有效性的因素。形成性评估(例如，现场访问、诊所观察以及与工作人员和患者的访谈)将用于促进两个站点采用基于网络的BAI，并为我们的Create业务合作伙伴提供循证指导，以便在全国范围内实施。为了解决目标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支出轨迹。我们计划收集几种类型的利用数据，包括门诊、住院和药房利用，并使用DSS成本数据计算治疗前和治疗后6个月每种类型的卫生保健利用所花费的总金额。

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.