Brief Intervention for Drug Misuse for the Emergency Department (BIDMED)

描述(由申请人提供)：尽管筛查、短暂干预和转介治疗(SBIRT)方法在减少酒精滥用及其相关冒险行为和负面后果方面有效，但很少有研究表明SBIRT对非法和/或处方药滥用有效。滥用非法药物和/或处方药的人经常到急诊科求医，特别是出于与滥用药物有关的原因。因此，教育署非常适合作为分析SBIRT对这类人群的效果的场所。急诊科药物滥用短期干预(BIDMED)研究是一项随机对照试验，将纳入大型学术创伤中心(罗德岛医院)和社区医院(Miriam医院)的成年ED患者，他们患有亚危重疾病或受伤，且筛查显示非法和/或处方药滥用。BIDMED参与者将被随机分为只接受筛查(SO)或接受短暂干预(BI)，并适当转介到治疗。参与者将使用标准化工具以及针对本研究目标调整的工具完成一系列盲目基线评估。所有参与者在随机化后的3个月、6个月和12个月接受盲法随访评估。BIDMED研究中提出的主要假设是，与SO组的参与者相比，BI组的参与者在以下方面表现出更大的减少：(1)在随机化后3个月的前30天内滥用药物，(2)在随机化后6个月与药物滥用相关的行为；(3)在随机化后12个月的负面身体健康、心理社会健康和社会经济后果。作为次要目标，BI与SO相比的影响将在参与者接触、登记和完成药物治疗计划时进行评估。此外，还将衡量与SO相比，BI在增加艾滋病毒感染率和乙肝/丙型肝炎筛查方面的影响。还将开发和测试一种变革机制模式，该模式涉及预期的变革调解人和调解人，以解释SBIRT在这一背景下的影响。此外，将在ED患者中随机抽样评估非法和/或处方药滥用的流行病学。公共卫生相关性：鉴于紧急医疗护理和药物滥用的交叉，如果SBIRT被证明对这类人群有效，教育署可以在减少药物滥用的公共卫生问题方面发挥重要作用。在急诊室因滥用药物而进行的SBIRT有可能在可能与药物滥用有关的急诊室就诊期间的“可教时刻”接触到人们。

DESCRIPTION (provided by applicant): Although screening, brief intervention, and referral to treatment (SBIRT) approaches are effective in reducing alcohol misuse and its associated risk-taking behaviors and negative consequences, there is little research demonstrating the effectiveness of SBIRT for illicit and/or prescription drug misuse. Misusers of illicit and/or prescription drugs frequently seek medical care in emergency departments (EDs), particularly for reasons related to their misuse. As a result, the ED is well suited as a site to conduct an analysis of the effectiveness of SBIRT for this population. The Brief Intervention for Drug Misuse for the Emergency Department (BIDMED) study is a randomized, controlled, trial that will include adult ED patients at a large, academic, trauma center (Rhode Island Hospital) and a community hospital (The Miriam Hospital) who have a subcritical illness or injury and whose screening indicates illicit and/or prescription drug misuse. BIDMED participants will be randomized to receive screening only (SO) or brief intervention (BI) with appropriate referral to treatment. Participants will complete a battery of blinded baseline assessments using standardized instruments as well as adapted instruments specific to the aims of this study. All participants will undergo blinded follow-up assessments at three, six, and twelve months post-randomization. The primary hypotheses addressed in the BIDMED study are that, compared to participants in the SO arm, participants in the BI arm will show a significantly greater reduction in: (1) drug misuse within the prior 30 days at three months post-randomization, (2) behaviors associated with drug misuse at six months post-randomization; and (3) negative physical health, psychosocial health, and socioeconomic consequences at twelve months post-randomization. As a secondary aim, the impact of BI compared to SO will be assessed on participants contacting, enrolling in, and completing a drug treatment program. In addition, the impact of BI compared to SO on increasing uptake of HIV and hepatitis B/C screening will be measured. A mechanisms of change model that addresses the expected mediators and moderators of change to explain the effects of SBIRT in this setting will also be developed and tested. Further, the epidemiology of illicit and/or prescription drug misuse will be assessed in a random sample of ED patients. PUBLIC HEALTH RELEVANCE: Given the intersection of emergency medical care and drug misuse, the ED could serve as a significant contributor in reducing the public health problem of drug misuse if SBIRT is shown to be effective for this population. SBIRT in the ED for drug misuse has the potential for reaching people during a "teachable moment" during an ED visit that might be related to drug misuse.