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

描述（由申请人提供）：成人危险酒精使用的筛查和短暂干预（SBI）一致确定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项目经常扩大到包括转诊治疗（又名SBIRT），以解决后一种患者的需求，并在初级保健中通过转诊增加了15-20%的治疗机会，但仍有80-85%的患者需要治疗。显然需要有效的模式将成人SUD与AOD治疗联系起来。恢复管理检查（RMC）是将患有SUDs的个体与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，进入时间更短，停留时间更长，有助于减少药物使用天数和减少SUD症状。RMC最近针对初级保健机构（RMC- pc）进行了修改，并在联邦合格卫生中心（FQHC）进行了试点。修改包括初级保健人群进行身体保健（而不是AOD治疗），拒绝转换组件，电话与面对面联系，以及在显示健康问题时转回初级保健。结果表明，RMC-PC使75%最初拒绝转诊到FQHC接受AOD治疗的患者转诊，并使这些个体的转诊率翻了四倍。在拟议的试验中，我们将：a)在4个fqhc中招募300名需要AOD治疗的成年人，b)随机分配一半接受SBIRT治疗，一半接受SBIRT+RMC-PC治疗，c)进行为期12个月的季度随访。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，c)接受更多AOD治疗天数；2)相对于SBIRT患者，SBIRT+ rmmc - pc患者和接受更多AOD治疗的患者报告的天数更少：a)酒精使用，b)重度酒精使用，c)大麻使用，d)其他药物使用，e) SUD问题；3)治疗天数将介导SBIRT+RMC-PC与这些AOD相关行为变化的关系；4)考虑AOD治疗增加的因素后，相对于SBIRT患者，SBIRT+RMC-PC患者和AOD使用天数较短的患者，其医疗保健总利用成本显著低于SBIRT患者；5)使用AOD天数将调解SBIRT+RMC-PC与医疗保健利用总成本之间的关系。

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.