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）：针对危险成人酒精使用的筛查和简短干预（SBI）始终确定5-10%的患者需要简短干预，2-5%需要更正式的酒精治疗。SBI方案往往扩大到包括转诊治疗（又名SBIRT），以解决后者患者的需求，在初级保健中，通过转诊获得治疗的机会增加了15-20%，但仍有80-85%的患者需要治疗。显然需要将SUD成人与AOD治疗联系起来的有效模式。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参与者更有可能进入治疗，更早进入，停留更长时间，有助于减少物质使用天数和SUD症状。RMC最近针对初级保健环境（RMC-PC）进行了修改，并在联邦合格的卫生中心（CIMHC）进行了试点。修改包括初级保健人口提出的身体健康护理（而不是AOD治疗），拒绝转换组件，电话与面对面的联系，并转介回初级保健时，健康问题的指示。结果表明，RMC-PC转换了75%的最初拒绝在CNOHC转诊接受AOD治疗的人，并将这些人的治疗联系率提高了四倍。 在拟议的试验中，我们将：a）招募300名需要在4个RMC接受AOD治疗的成年人，B）随机分配一半接受SBIRT，另一半接受SBIRT+RMC-PC，c）每季度进行一次随访，为期12个月。假设包括：1）相对于SBIRT患者，SBIRT+ RMC-PC患者将更有可能：a）更早地开始AOD治疗，B）接受任何AOD治疗，以及c）接受更多的AOD治疗天数; 2）相对于SBIRT患者，SBIRT+RMC-PC患者和接受更多AOD治疗的患者将报告更少的天数：a）酒精使用，B）重度酒精使用，c）大麻使用，d）其他药物使用，和e）SUD问题; 3）治疗天数将介导SBIRT+RMC-PC与这些AOD相关行为变化之间的关系; 4）相对于SBIRT患者，SBIRT+RMC-PC患者和使用AOD天数较少的患者在考虑AOD治疗增加后，总医疗保健使用成本显著降低; 5）AOD使用天数在SBIRT+RMC-PC与卫生保健利用总成本之间起中介作用。

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.