Implementing Mobile Technology for Unhealthy Alcohol Use in Emergency Departments

在急诊科实施移动技术以解决不健康的饮酒问题

• 批准号: 10577737
• 负责人: Megan Alison O'Grady
• 金额: $ 20.17万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577737
• 关键词: Accident and Emergency department; Address; Administrator; Adopted; Adoption; Adult; Alcohol consumption; Alcohols; Area; COVID-19 pandemic; Caring; Collaborations; Country; Data; Effectiveness; Electronic Health Record; Eligibility Determination; Emergency Department patient; Emergency department visit; Enrollment; Frequencies; Future; General Population; Health Services; Health Technology; Health behavior; Health system; Individual; Intervention; Interview; Learning; Meta-Analysis; Methods; Nature; Outcome; Patients; Pilot Projects; Population; Premature Mortality; Process; Promoting Action on Research Implementation in Health Services framework; Provider; Randomized; Research; Research Support; Resources; Sampling; Site; Structure; Surveys; Technology; Testing; Text; Text Messaging; Time; Training; Trauma patient; United States; United States National Institutes of Health; Work; World Health; alcohol involvement; alcohol misuse; alcohol screening; arm; behavioral health intervention; comparison control; drinking; effectiveness/implementation trial; emergency settings; evidence base; health care settings; implementation barriers; implementation facilitators; implementation strategy; interest; intervention mapping; mHealth; mobile computing; patient screening; pragmatic implementation; randomized trial; reduced alcohol use; response; screening and brief intervention; screening program; substance use; text messaging intervention

Project Summary Unhealthy alcohol use (UAU) is one of the leading causes of premature mortality among adults in the United States and has been increasing during the COVID-19 pandemic. UAU is more frequent among emergency department (ED) patients than in the general population and ED visits involving alcohol consumption have increased in recent years. Substance use has been described as the most important modifiable health behavior in the ED, and the ED has been highlighted as a key setting to intervene with UAU individuals. Consequently, health systems across the country need low burden, scalable ways to intervene with individuals but often have limited time and resources. Mobile technologies have been suggested as a solution to assist EDs in addressing UAU and one of the lowest burden, scalable approaches are text messaging interventions. Text messaging interventions for ED and trauma patients and other populations have shown good outcomes, including reductions in drinking quantity and frequency. Despite strong research support and promise for scalability, there is little evidence that technology-based behavioral health interventions can be effectively implemented into healthcare settings. There are few studies in which technology interventions for behavioral health are put into real world healthcare settings; those that have been conducted show that the benefits seen in randomized trials are often not realized. While EDs are promising venues for addressing UAU using text messaging interventions, the process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows (i.e., implementation in real-world ED settings) and patients adopting them remains a new area of research. This proposal builds on the longstanding collaboration of our interdisciplinary team on the implementation of substance use screening and brief interventions in healthcare settings. In response to the NIH Notice of Special Interest for Research in the Emergency Setting, we propose to examine potential barriers and facilitators to staff offering and patients accepting a text messaging intervention in the ED. We will then use a stakeholder-engaged Intervention Mapping process to develop a multi-component implementation strategy for EDs. Finally, we will conduct a mixed method 2-arm cluster- randomized pilot study in 4 EDs that serve ~13,000 UAU patients per year to assess the feasibility, acceptability and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide study activities. Low burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy. This 2-year R21 will prepare for a future, larger, fully-powered hybrid effectiveness-implementation trial.

项目总结