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

系统实施以患者为中心的饮酒护理试验：超越转诊治疗

基本信息

批准号：
10776775
负责人：
KATHARINE ANTHONY BRADLEY
金额：
$ 74.96万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10776775
关键词：
Address Adoption Adult Agreement Alcohol consumption Alcoholics Anonymous Alcohols Caring Cessation of life Clinic Clinical Counseling DSM-V Decision Aid Diagnosis Effectiveness Electronic Health Record Eligibility Determination Hybrids Individual International Intervention Label Language Measures Medical Medical Records National Committee for Quality Assurance National Institute on Alcohol Abuse and Alcoholism Outcome Pamphlets Patient Self-Report Patient-Centered Care Patients Persons Pharmaceutical Preparations Play Population Intervention Prevalence Primary Care Provider Public Health Randomized Recommendation Recovery Reporting Research Resources Role Sampling Social Workers Stigmatization Support Groups Surveys Symptoms Testing Thinking Time Visit Washington alcohol abuse therapy alcohol screening alcohol use disorder arm barrier to care comparison intervention coronavirus disease disability drinking effective therapy effectiveness-implementation randomized trial effectiveness/implementation trial experience follow-up implementation evaluation implementation facilitators implementation intervention implementation outcomes outreach patient engagement patient oriented peer support population based pragmatic trial preference pressure primary care clinic primary care patient primary care provider primary care team primary outcome randomized trial screening screening, brief intervention, referral, and treatment secondary outcome shared decision making social stigma therapy design treatment arm treatment as usual treatment program trial comparing usual care arm web site

项目摘要

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.

在此输入文本，它是您的应用程序的新摘要信息。此部分不得超过30行文本。总结。大约14%的美国成年人患有活跃性酒精使用障碍(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，没有发现单独的筛查、短期干预和转诊治疗(SBIRT)可以增加AUD的治疗。高质量的以患者为中心的初级保健通常依赖于共同的决策，这可以帮助激励患者并支持他们找到与他们的偏好一致的治疗方法。虽然患者可能更喜欢与他们的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共同决策的覆盖范围；系统扩展的集中方法可以减轻初级保健的负担，并具有更大的覆盖范围，但尚不清楚在缺乏已建立的临床关系的情况下，AUD的共同决策是否有效。具体目的：系统实施以患者为中心的酒精使用护理试验是一项务实、整群随机、有效性实施的试验，旨在测试两种干预措施，以系统地实施与澳州地区初级保健患者的共享决策：初级保健干预和集中干预。这项试验的具体目的是测试每一种干预措施是否(1)在一年的随访中增加了接受AUD治疗的初级保健患者的比例，或者(2)在两年的随访中减少了酒精的使用。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。这项试验将30家诊所随机分为三种管理AUD的方法之一：(1)常规护理；(2)在常规护理的基础上增加初级保健干预，使用最先进的实施干预措施，系统地鼓励初级保健提供者为AUD提供常规的共同决策；以及(3)在常规护理的基础上，系统地为AUD提供外展和由社会工作者共同决策的集中干预。试验样本包括1500名成人初级保健患者，根据他们的医疗记录中记录的DSM-5 AUD症状，他们是中-重度AUD的高风险患者。主要结果是：1)根据国家质量保证委员会(NCQA)的定义，在12个月的随访期间有记录的AUD治疗参与率(在开始接受AUD治疗后34天内2次就诊)，以及2)根据AUDIT-C评分从基线到9-24个月后的随访(无论治疗参与程度如何)，后续筛查时酒精使用的变化。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的决策，并将每个干预组的患者与普通护理组的患者进行比较。影响：超过3200万美国成年人患有活跃的澳元。许多人在初级保健中被发现，但很少有人转介到治疗中。这项试验将测试两种实际的基于人群的干预措施，以增加报告AUD症状的患者的治疗参与度。