Primary care prevention of stimulant diversion by high school students with ADHD

患有多动症的高中生兴奋剂转移的初级保健预防

• 批准号: 9125776
• 负责人: BROOKE S.G. MOLINA
• 金额: $ 59.4万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9125776
• 关键词: 17 year old; Address; Adolescence; Adolescent; Adopted; Affect; Alcohol or Other Drugs use; Attention deficit hyperactivity disorder; Attitude; Caring; Central Nervous System Stimulants; Child Rearing; Childhood; Clinical; Computerized Medical Record; Data; Development; Drug Prescriptions; Emergency department visit; Enrollment; Goals; Guidelines; Health; High School Student; Intervention; Legal; Mediating; Mediation; Medical; Medical center; National Institute of Drug Abuse; Outcome; Parents; Patients; Pattern; Perception; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention Protocols; Primary Health Care; Provider; Public Health; Randomized; Reporting; Research; Resistance; Risk; Risk Factors; Schedule; Self Efficacy; Source; Students; Testing; Time; Training; United States Substance Abuse and Mental Health Services Administration; Universities; Work; Youth; base; behavior change; clinical practice; college; cost; design; evidence base; externalizing behavior; high school; innovation; intervention effect; malleable risk; misuse of prescription only drugs; nonmedical use; older patient; pediatrician; peer; prevent; randomized trial; response; success; treatment as usual; trend; willingness

 DESCRIPTION (provided by applicant): Nonmedical use of psychoactive stimulant medication (medication that is prescribed for the treatment of Attention-Deficit/Hyperactivity Disorder; ADHD) is an increasingly prevalent form of prescription drug misuse among high school students (McCabe & West, 2013) and prevalence rates continue to rise. Stimulant-related emergency department visits increased threefold in recent years (SAMHSA, 2013a). Students with prescriptions are the primary source of stimulant diversion (selling, sharing one's medication). However, with the exception of developmental research we recently launched, clinical strategies for management of stimulant diversion have yet to be developed and empirically evaluated for primary care providers - a professional population that frequently treats ADHD and that is being targeted by NIDA (Volkow, 2012), especially with regard to nonmedical use of prescription drugs including stimulants (Volkow, 2010). Our work with primary care providers revealed 1) concern about the problem, 2) a lack of strategies for addressing it, and 3) willingness to adopt new strategies to decrease diversion potential. This application proposes to test the implementation of brief clinical practice strategies, designed to prevent stimulant diversion that pediatricians may use with their teenage patients receiving stimulant prescriptions and their parents. In response to RFA-DA-15-010, Interventions for youth who misuse/abuse prescription stimulant medications in high school and/or college-attending youth (U01)," we will conduct a randomized trial to examine the effect on patient diversion, attitudes, and intentions, of an intervention to be delivered by pediatric providers at the time of stimulant prescribing. N=375 13-17 year old patients will be enrolled across six pediatric practices for assessment prior to, and following, provider training in stimulant diversion practices. Following baseline assessment, providers at half of the practices, randomly selected within matched pairs, will receive training in the Stimulant Diversion Prevention (SDP) protocol; the remainder will implement Treatment as Usual (TAU). Providers and parents will also participate in the assessments and electronic medical record data will be collected for participating patients. We will also characterize prescribing patterns in all participating and non participating practices in the UPMC pediatric provider network independent of study participation (543 pediatricians) for comparison to regional trends. The results of this study will provide the first empirical test of a brief provider-led intervention for stimulant diversion reduction in primary care. The goals are innovative given the complete absence of such strategies in evidence-based ADHD treatment guidelines. The project addresses an immediate public health concern and is based on developmental work (R34 DA035464) that includes stakeholders (providers) as consultants to develop feasible strategies with a high likelihood of delivery. Thus, the impact of the work is expected to be high, with the result being a pragmatic, low cost, and highly disseminable means by which prescription stimulant diversion may be decreased.

 描述(由申请人提供)：非医疗用途的精神活性兴奋剂药物(用于治疗注意力缺陷/多动障碍的药物；ADHD)是高中生中日益普遍的处方药滥用形式(McCabe&West，2013)，患病率继续上升。近年来，与兴奋剂相关的急诊科就诊次数增加了三倍(SAMHSA，2013a)。有处方的学生是兴奋剂转移(出售、分享药物)的主要来源。然而，除了我们最近启动的发展研究外，初级保健提供者--经常治疗ADHD的专业人群，正成为NIDA的目标群体，特别是涉及包括兴奋剂在内的处方药的非医疗使用(Volkow，2010)--尚未制定管理兴奋剂转移的临床策略并进行实证评估。我们与初级保健提供者的合作揭示了1)对这个问题的担忧，2)缺乏解决这个问题的战略，以及3)愿意采取新的战略来减少转移的可能性。这项申请建议测试简短的临床实践策略的实施情况，旨在防止儿科医生与接受兴奋剂处方的青少年患者及其父母一起使用兴奋剂转移。为了回应RFA-DA-15-010，针对在高中和/或大学就读的青少年滥用/滥用处方兴奋剂的青少年的干预措施(U01)，我们将进行一项随机试验，以检查儿科提供者在以下时间提供的干预措施对患者分流、态度和意图的影响 兴奋剂处方。N=375名13-17岁的患者将在六个儿科实践中登记，以便在提供者培训兴奋剂转移实践之前和之后进行评估。在基线评估之后，在配对中随机选择的一半做法的提供者将接受兴奋剂转移预防(SDP)方案的培训；其余的将实施照常治疗(TAU)。医疗服务提供者和家长也将参与评估，并将为参与评估的患者收集电子病历数据。我们还将描述所有参与方和非参与方的处方模式 独立于研究参与的UPMC儿科提供者网络中的参与实践(543名儿科医生)，以与区域趋势进行比较。这项研究的结果将 为减少初级保健中的兴奋剂转移提供第一个由提供者主导的简短干预的经验性测试。鉴于循证ADHD治疗指南中完全没有这样的策略，这些目标是创新的。该项目解决了一个迫在眉睫的公共卫生问题，并以发展工作(R34 DA035464)为基础，其中包括利益攸关方(提供者)作为顾问，以制定具有很高交付可能性的可行战略。因此，预计这项工作的影响将很大，结果是一种务实、低成本和高度可传播性的手段，通过这种手段可以减少处方兴奋剂的转移。