Computer-facilitated Screening and Brief Intervention in pediatric primary care to reduce underage drinking: a large multi-site randomized trial

项目总结/摘要 酒精使用障碍通常有儿科起源。儿科初级保健办公室，其中大多数 青少年获得保健，是通过以下方式进行早期识别和干预的一个有希望的场所： 普遍筛查和简短咨询。然而，尽管美国预防服务工作组 建议以初级保健为基础的酒精筛查和对成年人的简短干预， 有证据表明青少年应该这样做。拟议研究的目标是通过以下方式解决这一证据缺口 测试一个有前途的计算机辅助筛查和简短干预（cSBI）系统的有效性， 儿科初级保健临床医生在井访视时向青少年提供服务。本研究采用随机对照 试验将在美国儿科学会（AAP）的儿科研究办公室环境中进行 （PROS）国家初级保健实践为基础的研究网络。PROS在>30个国家取得了成功 多年的基于实践的研究，有超过600个实践参与了最近的研究。在15个以上 多年来，我们对青少年酒精筛查和初级保健办公室的简短咨询进行了研究， cSBI系统的开发是为了为儿科实践提供一种时间效率高、可行的方法，以改善这两个方面 酒精筛查和咨询的频率和质量。cSBI包括：1）计算机自管理 青少年在看医生之前完成的筛查，2）计算机提供的个性化 向青少年提供反馈，3）为青少年提供10个关于药物使用的互动式心理教育网页 健康风险，4）临床医生报告表，其中包含临床医生用于提供的筛选结果和提示 基于动机访谈的个体化咨询，以及5）临床医生培训材料和方案。在 我们在新英格兰的试点研究中发现，与常规护理（UC）相比，cSBI方法：1） 增加患者在井访视期间接受酒精相关咨询; 2）改善患者对 他们的临床医生遇到的质量;和3）在基线时报告去年使用的那些人（n=192）中， 在12个月的随访中，重度间歇性饮酒的风险降低了34%。cSBI还 与受损司机一起乘车的风险降低了42%，这是与酒精相关的主要安全风险， 有骑马风险。这种方法的一个更大的随机对照试验，它采用了一个足够有力的样本和测试 新英格兰以外的影响的普遍性是必要的。我们建议随机选择>30名儿童原发性 护理临床医生在全国范围内的10个实践，提供UC或cSBI（1：1），他们的合格和同意14- 17- 年的病人前来探病。我们的目的是测试cSBI对重度间歇性饮酒的影响， 在1,268名青少年中进行的12个月随访中，与受损驾驶员一起骑行/在受损时驾驶 筛选确定为有风险。如果有效，cSBI的传播可以利用现有的AAP平台，包括 教育，教学和宣传，其67,000名儿科医生成员，大大增加了潜力， 美国青少年酒精筛查和短暂干预的人口水平影响。

PROJECT SUMMARY/ABSTRACT Alcohol use disorders frequently have a pediatric origin. Pediatric primary care offices, where the majority of adolescents receive health care, are a promising venue for early identification and intervention through universal screening and brief counseling. However, while the U.S. Preventive Services Task Force recommends primary care-based alcohol screening and brief intervention for adults, it found insufficient evidence to recommend it for adolescents. The goal of the proposed study is to address this evidence gap by testing the effectiveness of a promising computer-facilitated Screening and Brief Intervention (cSBI) system for delivery by pediatric primary care clinicians to adolescents at well-visits. This cluster-randomized controlled trial will be conducted in the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) national primary care practice-based research network. PROS has demonstrated success in >30 years of practice-based research, with >600 practices participating in recent studies. Drawing on more than 15 years of our prior research on adolescent alcohol screening and brief counseling in primary care offices, the cSBI system was developed to provide a time-efficient and feasible way for pediatric practices to improve both the frequency and quality of alcohol screening and counseling. cSBI includes: 1) computer self-administered screening that adolescents complete prior to seeing their clinician, 2) computer-delivered personalized feedback to the adolescent, 3) 10 interactive psychoeducational pages for the adolescent on substance use health risks, 4) a Clinician Report Form with screen results and prompts that clinicians use to provide motivational interviewing-based individualized counseling, and 5) clinician training materials and protocol. In our New England-based pilot study, we found that, compared to usual care (UC), the cSBI approach: 1) increased patient receipt of alcohol-related counseling during well-visits; 2) improved patients' ratings of the quality of their clinician encounter; and 3) among those who reported past-year use at baseline (n=192), was associated with a 34% lower risk of a heavy episodic drinking episode during 12 months follow-up. cSBI also reduced risk of riding with an impaired driver, a major safety risk associated with alcohol, by 42% among those with prior riding risk. A larger RCT of this approach, which employs an adequately-powered sample and tests generalizability of effects beyond New England, is needed. We propose to randomize >30 pediatric primary care clinicians in 10 practices nationwide to deliver UC or cSBI (1:1) to their eligible and assenting 14- to 17- year-old patients arriving for well-visits. Our aims are to test cSBI's effect on heavy episodic drinking, and on riding with an impaired driver/driving while impaired, during 12 months follow-up among 1,268 adolescents screen-identified as at-risk. If effective, cSBI dissemination could leverage existing AAP platforms including education, teaching, and advocacy, to its 67,000 pediatrician members, greatly increasing the potential for population-level impact of alcohol screening and brief intervention for U.S. adolescents.