mHealth to Enhance & Sustain Drug Use Reduction of the QUIT BI in Primary Care

增强移动医疗

• 批准号: 9974313
• 负责人: Lillian Gelberg
• 金额: $ 72.39万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9974313
• 关键词: Academy; Administrator; Adoption; Adult; Alcohol or Other Drugs use; Back; California; Car Phone; Caring; Chronic; Clinic; Clinical; Cognitive; Cost Effectiveness Analysis; Critiques; Data; Drug Controls; Drug Monitoring; Drug Recalls; Drug usage; Drug user; Effectiveness; Effectiveness of Interventions; Elements; Federally Qualified Health Center; Feedback; Fibrinogen; Future; Goals; Health; Informal Social Control; Insurance Carriers; Intervention; Intervention Trial; Legal; Low income; Measures; Medicine; Mental Health; Methods; Monitor; Motivation; Outcome; Pain; Patient Care; Patient Monitoring; Patient Preferences; Patient Self-Report; Patients; Pattern; Pharmaceutical Preparations; Pilot Projects; Policies; Prevention education; Prevention strategy; Primary Health Care; Problem Solving; Provider; Psychological reinforcement; Public Health; Qualitative Research; Quality of life; Randomized; Recommendation; Research; Rewards; Risk; Self Management; Self-Correction; Single-Blind Study; Subgroup; Substance Use Disorder; Symptoms; Tablet Computer; Techniques; Technology; Telephone; Testing; Text Messaging; Time; TimeLine; Urine; Use Effectiveness; Validation; Visit; Voice; Work; addiction; arm; base; behavioral health; care providers; comorbidity; comparative cost effectiveness; cost; cost effective; cost effectiveness; craving; dashboard; demographics; design; drug testing; effectiveness implementation study; ethnic minority population; follow-up; health service use; illicit drug use; implementation research; improved; mHealth; marijuana use; medical specialties; mobile application; motivational enhancement therapy; novel; opioid epidemic; opioid overdose; parity; patient oriented; patient screening; physical conditioning; preference; prevent; primary care setting; primary outcome; programs; response; scale up; screening and brief intervention; secondary outcome; substance use prevention; theories; three-arm study; tool; treatment as usual; trial comparing; uptake

PROJECT SUMMARY. The QUIT-Mobile study proposes to use mobile phone self-monitoring and feedback to enhance and sustain over 12-months the impacts of the Quit Using Drugs Intervention Trial (QUIT), an ef- fective screening and brief intervention (SBI) previously successful in reducing risky drug use (i.e., moderate use) in low-income, diverse patients over a 3-month follow up. We propose to conduct the QUIT-Mobile study for primary care patients who receive care in 8 clinics of federally qualified health centers (FQHC) in Southern California over 12-months follow up, comparing to QUIT and Usual Care (UC). The proposed study is an Effec- tiveness-Implementation Hybrid Type 1 design consisting of a single-blind, 3-arm, RCT with adult, mostly La- tino FQHC primary care patients with risky drug use (ASSIST score 4-26), randomized to 3 conditions (n=320/arm, n=960 total): 1) QUIT-Mobile; 2) standard QUIT; 3) Usual Care. Qualitative data on implementa- tion facilitators and barriers will inform future scale-up and sustainability, in addition to cost data and cost-effec- tiveness analysis. The aims are to examine effectiveness in reducing risky drug use and cost-effectiveness comparing the three arms over 3-, 6- and 12-months. Drug use measures include urine drug tests, and timeline follow-back self-reports for past 7-days and past 30-days (risky drug users have sporadic drug use patterns requiring longer self-report recalls for drug use that urine screens may not detect). The 3-arm study enables testing of the independent and synergistic effects of QUIT-Mobile compared to QUIT and both to Usual Care, acknowledging that mHealth components alone may not be effective outside of a clinical/coaching relationship. The 12-month timeline reflects anticipated scale-up scenarios of annual primary care visits when screening and brief intervention would be repeated routinely. QUIT contains 3 components: 1) patient screening with the WHO ASSIST, 2) brief clinician advice (<4 minutes) including opioid overdose prevention education, and 3) 2- and 6-week telephone drug-use health coaching sessions utilizing motivational interviewing and cognitive be- havioral techniques, delivered by paraprofessional health coaches. QUIT-Mobile proposes to test the addition of mobile phone self-monitoring, feedback, and coach monitoring dashboard to enhance and sustain QUIT's drug use reductions using mobile app, text-messaging (SMS), or interactive voice response (IVR) to allow par- ticipation by with varying technological preferences. This study does not test which technology platform is more effective, but rather, the effectiveness of the intervention functions (i.e., self-monitoring, automated feedback, coach monitoring) that are delivered via patients' preferred technologies. This study is novel and timely in inte- grating massively scalable mobile phone tools into an effective primary care BI to prevent substance use disor- der (SUD) in FQHC patients delivered by paraprofessionals. QUIT-Mobile is responsive to the National Opioid Crisis, and the US Mental Health Parity Act and National Academy of Medicine recommendations to integrate behavioral health SBIs into primary care settings to prevent higher level SUD requiring specialty treatment.

项目摘要。QUIT-移动的研究提出使用移动的手机进行自我监测和反馈 加强和维持超过12个月的影响，戒烟药物干预试验（QUIT），一个有效的， 有效筛查和简短干预（SBI）以前在减少危险药物使用方面取得了成功（即，中度 使用）在低收入，不同的患者超过3个月的随访。我们建议进行QUIT-Mobile研究 对于在南部联邦合格卫生中心（WHC）的8个诊所接受治疗的初级保健患者， 加州12个月随访，与戒烟和康复护理（UC）进行比较。这项研究是一个有效的- tiveness-Implementation混合1型设计，包括一项单盲、3组、RCT，成人，主要是La- 有风险药物使用（ASSIST评分4-26分）的tino HCHC初级保健患者，随机分配至3种条件 （n=320/组，共n=960）：1）QUIT-Mobile; 2）标准QUIT; 3）产后护理。关于执行情况的质量数据a 除了成本数据和成本效益外，促进因素和障碍将为未来的规模扩大和可持续性提供信息， 性分析。其目的是审查减少危险药物使用的有效性和成本效益 比较3个月、6个月和12个月的三组数据。药物使用测量包括尿液药物测试和时间轴 过去7天和过去30天的随访自我报告（风险药物使用者有零星的药物使用模式 需要更长的自我报告召回尿液筛查可能无法检测到的药物使用）。三组研究使 测试QUIT-Mobile与QUIT以及两者与泌尿护理相比的独立和协同效应， 承认移动健康组件单独可能无法在临床/教练关系之外有效。 12个月时间轴反映了筛查时年度初级保健访视的预期规模扩大情况 并定期重复简短的干预。QUIT包含3个组成部分：1）使用 WHO ASSIST，2）简短的临床医生建议（<4分钟），包括阿片类药物过量预防教育，和3）2- 以及为期6周的电话药物使用健康辅导课程，利用动机访谈和认知行为， 由准专业健康教练提供的口腔技术。QUIT-Mobile建议测试添加 移动的电话自我监控、反馈和教练监控仪表板，以增强和维持QUIT 使用移动的应用程序、短信（SMS）或交互式语音应答（IVR）减少药物使用， 不同的技术偏好。这项研究并没有测试哪种技术平台更多 有效，而是干预功能的有效性（即，自我监控，自动反馈， 教练监控），通过患者偏好的技术提供。本研究具有新颖性和及时性， 将大规模可扩展的移动的电话工具纳入有效的初级保健BI，以防止物质使用不当， der（SUD）在由辅助专业人员提供的CIMHC患者中。QUIT-Mobile对国家阿片类药物做出反应 危机，以及美国心理健康平价法案和国家医学院的整合建议 行为健康SBI纳入初级保健机构，以防止需要专科治疗的更高水平的SUD。