Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

描述（由申请人提供）：这是一个更新的“筛选青年AOD用途：一项研究的初级保健提供者。卫生系统尚未对青少年实施筛查、短期干预和转诊治疗，尽管研究表明其有效性。基于先前的研究，确定了在儿科初级保健（PC）中对青少年进行AOD筛查的障碍，以及一项发现SBIRT是可行的、广受欢迎的、促进转诊和启动专科治疗的试点研究，当前的研究申请建议在一个大型管理式保健卫生系统内的医疗中心的儿科诊所中随机分配初级保健医生（PCP），Kaiser Permanente北方加州，分为三个组：1）家庭护理; 2）PCP提供的SBIRT; 3）行为医学专家（BMS）提供的SBIRT。本研究的目的是比较三个研究组中SBIRT在PC青少年中的实施情况、有效性和成本效益。患者将完成循证筛查和AOD评估措施，这些措施已嵌入健康计划的电子病历（EMR）中。将使用混合模型比较12个月时的实施结局（筛查和识别率、简短干预、转诊至化学依赖性治疗和治疗启动）和有效性（AOD使用和戒断的患者结局）。该模型考虑了提供者内患者之间的类内相关性。将检查相对于实施和患者结局的成本效益。实施的障碍和促进因素，以及通过与临床医生和管理人员的定性访谈的可行性也将进行研究。这项研究是重要的，因为它探讨了必须解决的问题，以刺激广泛适应SBIRT。在当前的卫生改革环境下，由于联邦合格卫生中心和私人卫生计划的资源和培训增加，拟议的干预措施是非常可行的。它是创新性的使用电子病历改变临床实践和系统集成在PC上的AOD，并作为一个平台，收集研究数据。

DESCRIPTION (provided by applicant): This is a renewal of "Screening for Youth AOD Use: A Study of Primary Care Providers. Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiaion), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed intereventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.