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

项目概要/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，带来了重大挑战 给医疗保健提供者、患者和家庭。它与共病精神和医疗状况有关， 教育和就业成果不佳、事故和伤害以及可避免的卫生服务利用 和费用（例如急诊和住院）。早期开始使用 AOD 与酒精使用障碍有关 成年期。在儿科初级保健中提供筛查、简短干预和转诊治疗 (SBIRT) 是早期识别和干预的有效方法，可以减少 AOD 的使用和后果 和同时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优先事项的竞争以及缺乏训练有素的工作人员。研究 研究儿科初级保健中 SBIRT 实施的高效且具有成本效益的模式对于扩大儿童初级保健的覆盖范围至关重要 证据基础并支持更广泛的实施。大流行加速了行为远程医疗 解决青少年 AOD 使用和心理健康问题的方法正在获得动力，并提供了 扩大 SBIRT 在儿科初级保健中的覆盖面和影响力的潜力。本研究的目的是检验 是否有集中、虚拟交付的 SBIRT 模式，可供多个儿科初级儿童快速访问 护理诊所，可以经济高效地实施，以改善 AOD 的早期识别和治疗， AOD 使用障碍高风险或重度风险青少年中的共病心理健康问题。在这个完全 务实的 1 类混合比较有效性实施试验，以大型、真实的健康状况为背景 由于人口高度多样化，我们将随机抽取 20 个繁忙的普通儿科初级保健诊所，其中包括： 大约 22,320 名 12-17 岁青少年的合格人口，接受两个干预组之一：1) 集中行为健康中心通过视频或电话虚拟提供简短干预的诊所 临床医生（CV-SBIRT 部门），或 2) 诊所，其中由预约的简短干预措施由 分配到诊所的行为健康临床医生（传统 SBIRT 部门）。获得许可的行为健康 两组的临床医生将接受相同的经验支持的 SBIRT 方案的培训，不同之处仅在于其 交付方式。样本将包括所有接受健康访问的 12 至 17 岁青少年，他们 处于 AOD 使用障碍的高或严重风险中，定义为每月或更频繁地使用 AOD 或任何 AOD 使用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 在日常护理期间收集在电子健康记录中，以比较 SBIRT 的实施情况（简短的比率） 干预和转诊）、AOD 和心理健康结果（使用频率和症状认可和 诊断）、专业成瘾医学和精神病学治疗启动和参与、卫生服务 干预组 1 年和 2 年的使用情况（住院部和急诊科）以及成本效益 筛选后。

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.