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

增强移动医疗

基本信息

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
项目类别：
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

项目摘要

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。戒烟的研究建议使用手机自我监控和反馈为了增强和维持超过12个月的超过12个月的影响，使用药物干预试验（QUIT），EF- 以前成功降低风险使用药物的效力筛查和简短干预（SBI）（即中等）使用）在低收入中，在3个月的随访中，多样化的患者。我们建议进行戒烟研究对于在南部联邦资格卫生中心（FQHC）的8个诊所接受护理的初级保健患者而言加利福尼亚州超过12个月的随访，与戒烟和通常的护理（UC）相比。拟议的研究是一种效率能阻量实施杂种1型设计，由成人的单盲，3臂，RCT组成，主要是LA- Tino FQHC初级保健患者患有风险的药物使用（辅助评分4-26），随机分为3个条件（n = 320/臂，n = 960总计）：1）退出摩托车； 2）标准退出； 3）通常的护理。有关实施的定性数据 - 除成本数据和成本效益外，促进者和障碍还将为未来的扩大和可持续性提供信息能力分析。目的是检查降低危险的药物使用和成本效益的有效性比较3个，6个月和12个月以上的三个臂。药物使用措施包括尿液药物测试和时间表跟随过去7天和过去30天的自我报告（风险的吸毒者有零星的药物使用方式需要更长的自我报告召回尿液筛查可能无法检测到的毒品使用）。 3臂研究启用与戒烟相比，对退出摩托车的独立和协同作用的测试以及均与通常的护理相比承认仅在临床/教练关系之外，仅凭MHealth组件可能不会有效。 12个月的时间表反映了筛查时年度初级保健访问的预期缩放情况简短的干预将定期重复。退出包含3个组成部分：1）患者筛查谁协助，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，3）2- 利用动机访谈和认知能力的6周电话药物使用毒品使用健康教练会议由专业人士健康教练提供的避免技术。退出摩托车建议测试加法手机自我监控，反馈和教练监视仪表板以增强和维持戒烟使用移动应用程序，文本消息（SMS）或交互式语音响应（IVR）减少药物使用量，以允许使用通过不同的技术偏好来进行调整。这项研究没有测试哪个技术平台更多有效，而是干预功能的有效性（即自我监控，自动反馈，通过患者首选技术提供的教练监测）。这项研究是新颖的，并且及时将大规模可扩展的手机工具用于有效的初级保健BI，以防止使用物质使用 - 由专业人士分娩的FQHC患者中的DER（SUD）。退出摩托车对国家阿片类药物有反应危机以及美国心理健康奇偶校法案和国家医学学院的建议行为健康SBI进入初级保健环境，以防止需要专业治疗的更高水平的SUD。