Recovery Management Checkup for Primary Care (RMC-PC) vs. Screening Brief Intervention and Referral to Treatment (SBIRT) Experiment

初级保健恢复管理检查 (RMC-PC) 与筛查、简短干预和转诊治疗 (SBIRT) 实验

• 批准号: 9005570
• 负责人: Christy K Scott
• 金额: $ 53.9万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-27 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9005570
• 关键词: Address; Adopted; Adult; Advisory Committees; Affordable Care Act; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Appointment; Back; Beer; Behavior; Cessation of life; Child Care; Chronic; Clinic; Clinical; Conduct Clinical Trials; Control Groups; Dependence; Drug usage; Effectiveness; Enrollment; Family; Federally Qualified Health Center; Feedback; Friends; Future; Health; Health Care Costs; Health Services Accessibility; Healthcare; Heavy Drinking; Hypertension; Individual; Insurance; Lead; Life Style; Link; Measures; Mediating; Medical; Modeling; Modification; Motivation; Outcome; Participant; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Play; Population; Preventive service; Primary Health Care; Provider; Randomized; Recovery; Recruitment Activity; Reporting; Role; Savings; Schedule; Services; Social isolation; Societies; Substance Use Disorder; Symptoms; Techniques; Telephone; Transportation; addiction; alcohol abuse therapy; brief intervention; checkup examination; cost; design; disability-adjusted life years; experimental study; health care service utilization; improved; intervention program; marijuana use; motivational enhancement therapy; physical conditioning; primary care setting; programs; public health relevance; relative effectiveness; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; social stigma; support network; treatment as usual; treatment duration; trial comparing

DESCRIPTION (provided by applicant): Screening and Brief Intervention (SBI) for risky adult alcohol use consistently identifies 5-10% of patients in need of brief intervention and 2-5% in need of more formal alcohol treatment. SBI programs are often expanded to include Referral to Treatment (aka SBIRT) to address the latter patients' needs and in primary care have increased access to treatment by 15-20% via referrals leaving 80-85% still needing treatment. Effective models of linking adults with SUD to AOD treatment are clearly needed. Recovery Management Checkups (RMC) are an effective strategy for linking individuals with SUDs to AOD treatment. In 3 trials, compared to the control group, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, contributing to fewer days of substance use and fewer SUD symptoms. RMC was recently modified for primary care settings (RMC-PC) and piloted in Federally Qualified Health Centers (FQHC). Modifications include a primary care population presenting for physical health care (as opposed to AOD treatment), a refusal conversion component, telephone vs. face-to-face linkage, and referrals back to primary care when health problems are indicated. Results indicated that RMC-PC converted 75% of those who initially refused a referral for AOD treatment at the FQHC and quadrupled the linkage rate to treatment for these individuals. In the proposed trial, we will: a) recruit 300 adults needing AOD treatment at 4 FQHCs, b) randomly assign half to SBIRT and half to SBIRT+RMC-PC, and c) conduct quarterly follow-ups for 12-months. Hypotheses include: 1) Relative to the SBIRT patients, SBIRT+ RMC-PC patients will be more likely to: a) initiate AOD treatment sooner, b) receive any AOD treatment, and c) receive more days of AOD treatment; 2) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those who get more AOD treatment will report less days of: a) alcohol use, b) heavy alcohol use, c) cannabis use, d) other drug use, and e) SUD problems; 3) days of treatment will mediate the relationship between SBIRT+RMC-PC and changes in the these AOD related behaviors; 4) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those with fewer days of AOD use will have significantly less total health care utilization costs after factoring in increases in AOD treatment; 5) Days of AOD use will mediate the relationship between SBIRT+RMC-PC and total cost of health care utilization.

描述（由申请人提供）：针对成人饮酒风险的筛查和简短干预 (SBI) 始终识别出 5-10% 的患者需要短暂干预，2-5% 的患者需要更正式的酒精治疗。 SBI 计划通常会扩展到包括转诊治疗（又名 SBIRT），以满足后者的需求，并且在初级保健中，通过转诊将获得治疗的机会增加了 15-20%，使 80-85% 的患者仍需要治疗。显然需要将成人 SUD 与 AOD 治疗联系起来的有效模型。恢复管理检查 (RMC) 是将 SUD 患者与 AOD 治疗联系起来的有效策略。在 3 项试验中，与对照组相比，RMC 参与者明显更有可能进入治疗、进入治疗时间更早、停留时间更长，从而减少药物使用天数和 SUD 症状。 RMC 最近针对初级保健机构 (RMC-PC) 进行了修改，并在联邦合格健康中心 (FQHC) 进行了试点。修改包括初级保健人群接受身体保健（而不是 AOD 治疗）、拒绝转换部分、电话与面对面的联系，以及在出现健康问题时转介回初级保健。结果表明，RMC-PC 使 75% 最初拒绝转诊至 FQHC 接受 AOD 治疗的患者发生转变，并使这些患者的治疗关联率提高了四倍。 在拟议的试验中，我们将：a) 在 4 个 FQHC 招募 300 名需要 AOD 治疗的成年人，b) 随机分配一半接受 SBIRT，一半接受 SBIRT+RMC-PC，以及 c) 每季度进行为期 12 个月的随访。假设包括： 1) 相对于 SBIRT 患者，SBIRT+ RMC-PC 患者更有可能：a) 更早开始 AOD 治疗，b) 接受任何 AOD 治疗，以及 c) 接受更多天的 AOD 治疗； 2) 相对于 SBIRT 患者，SBIRT+RMC-PC 患者和接受更多 AOD 治疗的患者报告以下情况的天数较少：a) 饮酒，b) 大量饮酒，c) 大麻使用，d) 其他药物使用，以及 e) SUD 问题； 3) 治疗天数将调节 SBIRT+RMC-PC 之间的关系以及这些 AOD 相关行为的变化； 4) 相对于SBIRT患者，SBIRT+RMC-PC患者和AOD使用天数较少的患者在考虑AOD治疗增加的因素后，总医疗保健利用成本将显着降低； 5) AOD 使用天数将调节 SBIRT+RMC-PC 与医疗保健利用总成本之间的关系。