Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN)

项目总结 超过三分之一的美国成年人使用不健康的物质(USU)，包括光谱 从任何非法药物使用或酒精消费超过指南建议的水平到更多 严重的药物使用障碍。USU通过过量用药和大量发病率导致死亡率增加 包括功能下降、慢性病结果更差以及卫生保健利用率增加。一个大女人 一系列生物、心理和社会因素促成了USU。然而，虽然初级保健临床医生 经常遇到USU患者，他们很少使用全面的 将考虑到所有这些因素的方法。此外，改善USU的现有战略和模式 关怀往往没有考虑到实践和社区背景，因此没有得到广泛传播。 在我们的研究中，通过全人方法和使用者支持不健康的物质使用护理 以融入初级保健(可持续)为中心，我们建议利用初级保健实践和 有USU生活经历的个体在编码设计整体USU干预和协作测试时的经验 在初级保健实践中实施可持续干预。在我们研究的第一阶段，我们将 召集一系列利益相关者小组，由实践代表和USU的个人组成，他们将 共同设计一套改革方案，其中包括一系列干预措施，其中考虑了心理、社会和 导致USU的生物因素。在第二阶段，我们将进行整群随机对照试验， 来自两个基于实践的研究网络的24个诊所的等待名单控制，每个诊所有50名患者，WWAMI (华盛顿州、怀俄明州、阿拉斯加州、蒙大拿州和爱达荷州)地区实践和研究网络和弗吉尼亚州 门诊护理结果研究网络。参与实践将加入一个学习协作项目， 将支持他们实施他们的定制方法，通过选择 从第一阶段开发的干预措施菜单中选择。主要结果将是患者功能 (由PROIS-29-V2衡量)和次要结果将包括使用不健康的物质(TAPS-1)， 恢复(RAS)、卫生保健利用和进程成果。在综合框架的指导下 实施研究(CFIR)，我们将评估实施结果并进行定性 采访了部分患者和临床医生。我们建议的干预措施将提高公平性，因为 干预措施可以适应每个实践和实践所服务的个人的需要和偏好。 它的创新之处在于，它超越了目前对实施特定模式的关注，并认识到 适应所服务社区初级保健做法、组织结构和支付方式的多样性 模特们。如果成功，持续模式可以改变初级保健做法对患有 USU以可持续和全人的方式，改善患者的预后并加强社区。

PROJECT SUMMARY Over a third of American adults engage in unhealthy substance use (USU), which includes a spectrum ranging from any illicit drug use or alcohol consumption above guideline-recommended levels through more severe substance use disorder. USU results in increased mortality through overdose and substantial morbidity including reduced functioning, poorer chronic disease outcomes and increased health care utilization. A broad range of biological, psychological and social factors contribute to USU. However, while primary care clinicians frequently encounter patients with USU, they rarely screen for, diagnose, or treat USU using a comprehensive approach that would account for all these factors. Furthermore, existing strategies and models to improve USU care frequently fail to consider practice and community context, and thus have not been widely disseminated. In our study, Supporting Unhealthy Substance use care Through a whole person Approach and user centered INtegration into primary care (SUSTAIN), we propose to engage primary care practices and individuals with lived USU experience in codesigning a whole person USU intervention and collaboratively test the implementation of the SUSTAIN intervention in primary care practices. In phase 1 of our study, we will convene a series of stakeholder groups with practice representatives and individuals with USU who will codesign a change package that includes a menu of interventions that considers the psychological, social, and biological factors that contribute to USU. In phase 2, we will conduct a cluster randomized controlled trial with waitlist control in 24 practices with 50 patients each from 2 practice-based research networks, the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network and the Virginia Ambulatory Care Outcomes Research Network. Participating practices will join a learning collaborative where they will be supported in implementing their customized approach to identifying and treating USU by selecting from the menu of interventions developed in Phase 1. The primary outcome will be patient functioning (measured by the PROMIS-29-v2) and secondary outcomes will include unhealthy substance use (TAPS-1), recovery (RAS), health care utilization and process outcomes. Guided by the Consolidated Framework for Implementation Research (CFIR), we will evaluate implementation outcomes and conduct qualitative interviews with a subset of patients and clinicians. Our proposed intervention will enhance equity since the intervention is adaptable to the needs and preferences of each practice and individuals served by the practice. It is innovative in that it transcends the current focus on implementing a specific model and recognizes and adapts to the diversity of primary care practices in communities served, organizational structures and payment models. If successful, the SUSTAIN model can transform how primary care practices care for individuals with USU in a sustainable and whole person approach, improving patient outcomes and enhancing communities.