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

项目摘要/摘要 酒精使用障碍通常源于儿科。儿科初级保健办公室，那里的大多数 青少年得到医疗保健，是早期识别和干预的有希望的场所，通过 普遍筛查和简短咨询。然而，虽然美国预防服务工作组 建议对成年人进行以初级保健为基础的酒精筛查和短暂干预，发现不足 向青少年推荐它的证据。拟议研究的目标是通过以下方式解决这一证据差距 测试一种前景看好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探视时为青少年接生。这组随机对照 试验将在美国儿科学会(AAP)的办公室环境中进行儿科研究 (PROS)国家初级保健实践研究网络。专业人士已在&gt；30中展示了成功 多年以实践为基础的研究，&gt；600实践参与了最近的研究。在15个以上的位置绘制 多年来，我们在初级保健办公室对青少年酒精筛查和短暂咨询进行了研究， CSBI系统的开发是为了为儿科实践提供一种既省时又可行的方法来改善两者 酒精筛选和咨询的频率和质量。CSBI包括：1)计算机自我管理 青少年在看临床医生之前完成的筛查，2)计算机提供的个性化服务 给青少年的反馈，3)10个关于物质使用的青少年互动心理教育页面 健康风险，4)临床医生报告表，其中包含临床医生用来提供的筛选结果和提示 以激励性访谈为基础的个性化咨询，以及5)临床医生培训材料和方案。在……里面 我们在新英格兰进行的试点研究发现，与常规护理(UC)相比，cSBI方法：1) 增加了患者在探井期间接受与酒精有关的咨询的机会；2)提高了患者对 他们的临床就诊质量；3)在那些报告过去一年使用基线(n=192)的人中， 在12个月的随访中，大量饮酒的风险降低了34%。CSBI也 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 有优先骑行风险。这种方法的一个更大的随机对照试验，它使用了足够强大的样本和测试 需要对新英格兰以外的影响一概而论。我们建议将&gt；30名儿童初级医生随机分组 在全国范围内提供10个诊所的护理临床医生，向符合条件并批准14至17岁的人提供UC或cSBI(1：1) 一岁大的病人前来探望。我们的目标是测试cSBI对重度间歇性饮酒的影响，以及 在1268名青少年的12个月随访期间，与受损司机/在受损时驾驶的人一起乘车 筛查-被确认为处于危险之中。如果有效，cSBI传播可以利用现有的AAP平台，包括 向其67,000名儿科医生成员提供教育、教学和宣传，极大地增加了 酒精筛查和短暂干预对美国青少年的人口水平影响。

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.