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

项目摘要 超过三分之一的美国成年人从事不健康的物质使用（USU），其中包括一系列 范围从任何非法药物使用或酒精消费超过指南建议的水平， 严重的物质使用障碍USU通过过量和大量发病导致死亡率增加 包括功能下降、慢性病结果较差和医疗保健利用增加。广泛 一系列的生物，心理和社会因素有助于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方法筛查、诊断或治疗USU。 一种能解释所有这些因素的方法。此外，现有的战略和模型，以提高USU 护理往往不考虑实践和社区背景，因此没有得到广泛传播。 在我们的研究中，通过全人方法和用户支持不健康物质使用护理 中心整合到初级保健（持续），我们建议从事初级保健的做法， 在共同设计整个人USU干预和协作测试中具有USU现场经验的个人 在初级保健实践中实施可持续发展信息系统干预措施。在研究的第一阶段，我们将 召集一系列利益相关者团体与实践代表和个人与USU谁将 共同设计一套改变方案，其中包括一系列考虑心理、社会和 在第二阶段，我们将进行一项随机分组对照试验， 等待名单控制在24个实践与50例患者，每个从2个实践为基础的研究网络，WWAMI （华盛顿、怀俄明州、阿拉斯加、蒙大拿州和爱达荷州）地区实践和研究网络以及弗吉尼亚州 门诊护理结果研究网络。参与的实践将加入一个学习协作， 他们将在实施其定制的识别和处理USU的方法时得到支持， 从第一阶段制定的干预措施菜单中。主要结局将是患者功能 （通过PROMIS-29-v2测量），次要结果将包括不健康物质使用（TAPS-1）， 恢复（RAS），医疗保健利用和过程结果。在《综合框架》的指导下， 实施研究（CFIR），我们将评估实施结果，并进行定性研究。 采访了一部分患者和临床医生。我们提议的干预措施将加强公平，因为 干预措施可根据每一种做法及其所服务的个人的需要和偏好进行调整。 它的创新之处在于，它超越了目前对实施特定模式的关注， 适应所服务社区的初级保健做法、组织结构和支付方式的多样性 模型如果成功，SUSTAIN模式可以改变初级保健实践如何照顾个人， USU以可持续和全人的方式，改善患者的治疗效果和加强社区。

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.