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Leveraging technology to address unhealthy drug use in primary care settings

利用技术解决初级保健机构中不健康的药物使用问题

基本信息

批准号：
9016861
负责人：
Jennifer McNeely
金额：
$ 25.43万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9016861
关键词：
Address Adoption Affect Alcohol consumption Alcohol or Other Drugs use Back Behavior Caring Cessation of life Characteristics Chronic Clinical Clinical assessments Consumption Counseling Data Development Dose Drug usage Early Intervention Early identification Electronic Health Record Elements Enrollment Failure Feedback Focus Groups Goals Health Health Educators Healthcare Healthcare Systems Individual Intervention Interview Knowledge Mainstreaming Medical Methods Modeling Participant Patients Pharmaceutical Preparations Population Primary Health Care Provider Randomized Clinical Trials Randomized Controlled Trials Research Risk Self-Administered Services Site Specialist Substance Use Disorder Surveys Tablet Computer Technology Testing Time Visit base brief alcohol intervention brief intervention design follow-up health information technology improved information gathering innovation meetings novel strategies point of care population health prevent primary care setting screening screening, brief intervention, referral, and treatment substance abuse treatment support tools tool treatment program usability

项目摘要

DESCRIPTION (provided by applicant): The failure to identify and treat unhealthy drug use among patients seen in mainstream primary care settings represents a missed opportunity to improve population health. Screening, brief intervention, and referral to treatment (SBIRT) programs have been promoted to address this, but recent randomized clinical trials have demonstrated lack of efficacy. It is time to go 'back to the drawing board' to examine new models of care that could effectively address unhealthy drug use in primary care settings. SBIRT studies have only tested a 'specialist' model, which shifts the responsibility for screening and interventions onto a specialized health educator who is not part of the regular primary care team. An alternative model, which integrates screening and interventions into regular primary care, using the same approaches that are effective for other common chronic health conditions, may be more effective for reducing unhealthy drug use. Innovative application of health information technology can overcome barriers to implementing a primary care-integrated approach. The tablet computer-based Substance Use Screening and Intervention Tool (SUSIT) is designed to increase delivery of substance use brief interventions by primary care providers. The SUSIT is informed by the Technology Acceptance Model, and has three elements: 1) time and workflow constraints are addressed with patient self-administered screening completed before the clinical encounter, with results presented to the primary care provider at the point of care; 2) provider knowledge is enhanced with clinical decision support (CDS),which has proven effective at changing provider behavior to effectively address other health conditions; and 3) provider activation is improved with clinical reminders at every primary care visit. The screening component of the SUSIT has already been developed. The objective here is to build the clinical decision support, and then test the full SUSIT model with 10 primary care providers. A mixed methods approach will assess its acceptability and adoption among providers and patients, and gather preliminary data on its efficacy for reducing moderate-risk drug use (defined as unhealthy use that is below the threshold of a substance use disorder). A pre-post design will ascertain the dose of substance use intervention received and changes in drug use among patients enrolled in the screening only (SO) versus SUSIT intervention period (n=75 in each period). There are 3 specific aims: Aim 1 is to develop clinical decision support that assists primary care providers in carrying out a brief intervention. Aim 2 is to assess the impact of the SUSIT on dose of substance use brief intervention received by patients, and Aim 3 is to gather preliminary evidence on the efficacy of the SUSIT approach for reducing moderate-risk drug use. The innovation of the SUSIT approach is to leverage health information technology to support efficient and effective delivery of substance use screening and interventions. The significance of this research is that it develops and tests an alternative, practice-integrated model for addressing unhealthy drug use in primary care.

描述（由申请人提供）：在主流初级保健机构中未能识别和治疗不健康药物使用的患者意味着错失了改善人口健康的机会。为了解决这个问题，已经推广了筛查、简短干预和转诊治疗 (SBIRT) 计划，但最近的随机临床试验表明缺乏疗效。现在是时候“回到绘图板”来研究新的护理模式，以有效解决初级保健机构中不健康的药物使用问题。 SBIRT 研究仅测试了“专家”模式，该模式将筛查和干预的责任转移给不属于常规初级保健团队的专业健康教育者。另一种模式将筛查和干预措施纳入常规初级保健，使用对其他常见慢性健康状况有效的相同方法，可能更有效地减少不健康的药物使用。卫生信息技术的创新应用可以克服实施初级保健综合方法的障碍。基于平板电脑的药物使用筛查和干预工具 (SUSIT) 旨在增加初级保健提供者提供的药物使用简短干预措施。 SUSIT 以技术接受模型为基础，具有三个要素：1) 通过在临床就诊之前完成的患者自我管理筛查来解决时间和工作流程限制，并在护理时将结果提交给初级保健提供者； 2) 通过临床决策支持 (CDS) 增强提供者的知识，事实证明，这可以有效改变提供者的行为，从而有效解决其他健康状况； 3) 通过每次初级保健就诊时的临床提醒，改善提供者的激活。 SUIT 的筛选组件已经开发出来。这里的目标是建立临床决策支持，然后与 10 名初级保健提供者一起测试完整的 SUIT 模型。混合方法将评估其在提供者和患者中的可接受性和采用率，并收集其减少中度风险药物使用（定义为低于物质使用障碍阈值的不健康使用）功效的初步数据。前后设计将确定仅参加筛选 (SO) 与 SUSIT 干预期的患者接受的物质使用干预的剂量和药物使用的变化（每个时期 n=75）。有 3 个具体目标：目标 1 是开发临床决策支持，帮助初级保健提供者进行简短的干预。目标 2 是评估 SUSIT 对患者接受的药物使用简短干预剂量的影响，目标 3 是收集有关 SUSIT 方法减少中度风险药物使用功效的初步证据。 SUIT 方法的创新之处在于利用健康信息技术来支持高效、有效地提供物质使用筛查和干预措施。这项研究的意义在于，它开发并测试了一种替代的、实践整合的模型，用于解决初级保健中不健康的药物使用问题。