Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth

项目摘要/摘要 青少年酒精和其他药物(AOD)的使用是一个重大的公共卫生问题，构成了重大挑战 提供给医疗服务提供者、患者和家庭。它与并存的精神疾病和医学疾病有关， 教育和就业成果差、事故和伤害以及可避免的卫生服务利用率 费用(如急诊费和住院费)。早期使用AOD与酒精使用障碍相关 成人期。儿科初级保健的筛查、短期干预和转诊治疗(SBIRT) 是一种早期识别和干预的有效方法，可以减少AOD的使用和后果 和共同出现的心理健康症状，但由于各种障碍，缺乏广泛的实施， 包括儿科医生面临的时间限制和相互竞争的优先事项，以及缺乏训练有素的工作人员。研究 关于在儿科初级保健中提供SBIRT的有效和经济高效的模式对于扩大 证据基础和支持更广泛的执行。大流行加速了行为远程医疗 解决青少年AOD使用和精神健康问题的方法正在获得势头，并提供 增加SBIRT在儿科初级保健中的覆盖范围和影响的潜力。这项研究的目的是检查 SBIRT是否是一种集中式虚拟交付方式，可由多个儿科初级医生快速访问 护理诊所，可以经济有效地实施，以改善AOD和AOD的早期识别和治疗 AOD使用障碍高危或严重风险青少年的共病心理健康问题。在这个完整的 务实，类型1混合比较有效性实施试验，设置在一个大型的，真实的健康世界 对于人口高度多样化的系统，我们将随机选择20家繁忙的普通儿科初级保健诊所 将大约22,320名12-17岁的符合条件的青少年转移到两个干预部门之一：1) 由集中的行为健康中心通过视频或电话虚拟地提供简短干预的诊所 临床医生(CV-SBIRT ARM)，或2)诊所，其中基于预约的简短干预由 分配到诊所的行为健康临床医生(传统的SBIRT ARM)。持证行为健康 两个分支的临床医生将接受相同的经验支持的SBIRT方案的培训，只是 交付方式。样本将包括所有12至17岁的青少年进行探井，他们 是否存在AOD使用障碍的高风险或严重风险，定义为认可每月或更频繁使用AOD或任何 使用AOD和过去两周的抑郁症状或自杀倾向。我们将使用管理和临床数据 在常规护理期间在电子健康记录中收集以比较SBIRT实施情况(简单率 干预和转诊)、AOD和精神健康结果(使用频率和症状认可以及 诊断)、专业成瘾医学和精神病学治疗启动和参与、保健服务 使用(住院和急诊科)，1年和2年干预措施的成本效益 放映后。

PROJECT SUMMARY/ABSTRACT Adolescent alcohol and other drug (AOD) use is a major public health concern posing significant challenges to healthcare providers, patients and families. It is associated with comorbid psychiatric and medical conditions, poor educational and employment outcomes, accidents and injuries, and avoidable health services utilization and costs (e.g., emergency and inpatient). Early AOD use initiation is associated with alcohol use disorders in adulthood. Screening, Brief Intervention and Referral to Treatment (SBIRT) delivered in pediatric primary care is an effective approach to early identification and intervention and can reduce both AOD use and consequences and co-occurring mental health symptoms, yet widespread implementation is lacking, due to a variety of barriers, including the time constraints and competing priorities faced by pediatricians and lack of trained staff. Research on efficient and cost-effective modalities of SBIRT delivery in pediatric primary care is critical to expanding the evidence base and supporting broader implementation. Accelerated by the pandemic, behavioral telemedicine approaches to addressing adolescent AOD use and mental health problems are gaining momentum and offer the potential to increase the reach and impact of SBIRT in pediatric primary care. This study’s objective is to examine whether a centralized, virtually delivered modality of SBIRT, rapidly accessible by multiple pediatric primary care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD and comorbid mental health problems among adolescents at high or severe risk of AOD use disorder . In this wholly pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation trial, set in a large, real-world health system with a highly diverse population, we will randomize 20 busy, general pediatric primary care clinics with an eligible population of approximately 22,320 12-17 year old adolescents, to one of two intervention arms: 1) clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health clinician (CV-SBIRT arm), or 2) clinics where appointment-based brief interventions are delivered by a behavioral health clinician assigned to the clinic (Traditional SBIRT arm). Licensed behavioral health clinicians in both arms will be trained in the same empirically supported SBIRT protocol, differing only in its modality of delivery. The sample will include all adolescents aged 12 through 17 years seen for a Well Visit, who are at high or severe risk of AOD use disorder defined as endorsing monthly or more frequent AOD use OR any AOD use and past-two-week depressive symptoms or suicidality. We will use administrative and clinical data collected in the electronic health record during routine care to compare SBIRT implementation (rates of brief interventions and referrals), AOD and mental health outcomes (use frequency and symptom endorsement and diagnoses), specialty Addiction Medicine and Psychiatry treatment initiation and engagement, health services use (inpatient and Emergency Department), and cost-effectiveness in the intervention arms, at 1 and 2 years post-screening.