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

支持不健康药物使用护理 通过全人方法和以用户为中心 融入初级护理（持续）

• 批准号: 10827292
• 负责人: Sebastian Tong
• 金额: $ 62.5万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10827292
• 关键词: Supporting; Unhealthy; Substance; use; care

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.

项目摘要 超过三分之一的美国成年人从事不健康的药物使用（USU），其中包括频谱 从任何非法药物使用或饮酒量以上是指导式推荐的水平以上的范围 严重的药物使用障碍。 USU通过过量和大量发病率增加死亡率 包括功能降低，较差的慢性疾病结局和增加医疗保健利用。广泛 生物，心理和社会因素范围促成了USU。但是，初级保健临床医生 经常使用USU遇到患者，他们很少使用全面筛选，诊断或治疗USU 可以解释所有这些因素的方法。此外，改善USU的现有策略和模型 护理经常无法考虑实践和社区环境，因此并未被广泛传播。 在我们的研究中，通过整个人的方法和用户支持不健康的药物护理 我们建议将初级保健融入初级保健（susta），以参与初级保健实践和 拥有USU经验的个人在编码整个人的USU干预和协作测试方面 实施在初级保健实践中的维持干预。在我们研究的第一阶段中，我们将 召集一系列利益相关者团体与实践代表和usu的个人 编码一个更改包，其中包括一系列干预措施，以考虑心理，社交和 有助于USU的生物因素。在第2阶段，我们将进行一项群集随机对照试验 24个实践的候补控制列表控制，每人来自2个基于实践的研究网络的50名患者，第二次世界大战 （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 门诊护理结果研究网络。参与实践将加入学习合作 他们将通过选择他们的定制方法来识别和治疗USU，从而支持他们 从第1阶段开发的干预措施菜单。主要结果将是患者的功能 （通过Promis-29-V2衡量）和次要结果将包括不健康的药物使用（TAPS-1）， 恢复（RAS），医疗保健利用和过程成果。在合并框架的指导下 实施研究（CFIR），我们将评估实施结果并进行定性 接受一部分患者和临床医生的访谈。我们提议的干预将提高公平，因为 干预适应每种实践的需求和偏好以及实践所服务的个人。 它具有创新性，因为它超越了当前对实施特定模型并认识和认可和的关注 适应所服务社区，组织结构和付款的初级保健实践的多样性 型号。如果成功，维持模型可以改变初级保健实践如何照顾 在可持续和全人的方法中，USU改善了患者的结果并增强了社区。