Systematic Implementation of Patient-centered Care for Alcohol Use Trial: Beyond Referral to Treatment

在此输入文本，它是应用程序的新摘要信息。此部分不得超过30行文本。 摘要大约14%的美国成年人患有活跃的酒精使用障碍（AUD），大多数人从未接受过治疗。专家们一致认为，初级保健应该在识别AUD和让患者参与治疗方面发挥重要作用。然而，筛查，短暂干预和转诊治疗（SBIRT）单独尚未发现增加AUD治疗。高质量的以患者为中心的初级保健通常依赖于共同决策，这有助于激励患者并支持他们找到符合其偏好的治疗方法。虽然患者可能更喜欢与其初级保健提供者共同决策，但初级保健中的时间压力和其他障碍可能会限制初级保健中共同决策的范围;系统性外展的集中方法可以减轻初级保健的负担，并具有更大的范围，但尚不清楚在没有建立临床关系的情况下，AUD的共同决策是否有效。具体目标：系统实施以患者为中心的酒精使用护理试验是一项务实的、随机分组的、有效性实施试验，测试两种干预措施，以系统地实施对AUD初级保健患者的共同决策：初级保健干预和集中干预。该试验的具体目的是测试每种干预措施-与单独的常规治疗相比-是否（1）在一年随访期间增加了参与AUD治疗的初级保健患者的比例或（2）在2年随访期间减少了酒精使用。方法：拟议的试验在30个初级保健诊所进行，其中常规护理包括SBIRT。该试验将30家诊所随机分为三种方法来管理AUD：（1）常规护理;（2）在常规护理基础上增加初级护理干预，使用最先进的实施干预措施，系统地鼓励初级护理提供者为AUD提供常规共同决策;以及（3）在常规护理的基础上增加集中干预，由社会工作者系统地为AUD提供外展和共同决策。试验样本包括1，500名成人初级保健患者，他们根据病历中记录的DSM-5 AUD症状处于中重度AUD的高风险中。主要结果是：1）根据国家质量保证委员会（NCQA）的定义，在12个月随访期间记录的AUD治疗参与率（在开始后34天内进行2次AUD治疗访视），以及2）基于AUDIT-C评分从基线到9-24个月后随访的变化，随访筛选时酒精使用的变化（不考虑治疗参与）。意向治疗分析包括所有符合条件的患者，无论他们是否接受共同决策，并将每个干预组的患者与常规护理组的患者进行比较。影响：超过3200万美国成年人患有活动性AUD。许多人在初级保健中被发现，但很少有人接受转诊治疗。该试验将测试两种基于人群的实用干预措施，以增加报告AUD症状的患者的治疗参与度。

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. SUMMARY. About 14% of US adults have an active alcohol use disorder (AUD) and most never receive treatment. Experts agree primary care should play a major role in identifying AUD and engaging patients in treatment. However, screening, brief intervention and referral to treatment (SBIRT) alone has not been found to increase AUD treatment. High-quality patient-centered primary care usually relies on shared decision-making, which can help motivate patients and support them in finding treatments that are aligned with their preferences. While patients likely prefer shared decision-making with their primary care providers, time pressures and other barriers in primary care may limit the reach of shared decision-making in primary care; centralized approaches with systematic outreach could decrease the burden on primary care and have greater reach, but it is unknown whether shared decision-making for AUD will be effective in the absence of an established clinical relationship. SPECIFIC AIMS: The Systematic Implementation of Patient-centered Care for Alcohol Use Trial is a pragmatic, cluster-randomized, effectiveness-implementation trial testing two interventions to systematically implement shared decision-making with primary care patients with AUD: a primary care intervention and a centralized intervention. The specific aims of the trial are to test whether each intervention—compared to usual care alone—(1) increases the proportion of primary care patients engaged in AUD treatment over a year follow-up or (2) decreases alcohol use over 2 years follow-up. METHODS: The proposed trial is conducted in 30 primary care clinics in which usual care includes SBIRT. The trial randomizes the 30 clinics to one of three approaches to managing AUD: (1) usual care; (2) a primary care intervention added to usual care that uses state-of-the-art implementation interventions to systematically encourage primary care providers to offer routine shared decision-making for AUD; and (3) a centralized intervention added to usual care that systematically offers outreach and shared decision-making for AUD by a social worker. The trial sample includes 1,500 adult primary care patients who are at high-risk for moderate-severe AUD based on DSM-5 AUD symptoms documented in their medical records. Primary outcomes are: 1) the prevalence of documented AUD treatment engagement during 12 months of follow-up per National Committee for Quality Assurance (NCQA) definitions (2 visits for AUD treatment in the 34 days after initiation), and 2) changes in alcohol use at follow-up screening based on changes in the AUDIT-C score from baseline to follow-up 9-24 months later (irrespective of treatment engagement). Intent to treat analyses include all eligible patients regardless of whether they receive shared decision-making and compare patients in each intervention arm to those in the usual care arm. IMPACT: Over 32 million US adults have active AUD. Many are identified in primary care but few engage in referrals to treatment. This trial will test two practical population-based interventions to increase treatment engagement in patients who report AUD symptoms.