Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth

儿科初级保健虚拟 SBIRT：通过远程医疗增加酒精和其他药物使用筛查、简短干预和转诊治疗的机会

• 批准号: 10606351
• 负责人: Stacy Ann Sterling
• 金额: $ 63.88万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606351
• 关键词: 17 year old; Academy; Accident and Emergency department; Accidents; Address; Adolescent; Adolescent Psychiatry; Adult; Affect; Alcohols; American; Anxiety; Appointment; Behavioral; Child Psychiatry; Childhood; Clinic; Clinical Data; Depression and Suicide; Diagnosis; Drug Use Disorder; Drug usage; Early Intervention; Early identification; Early treatment; Electronic Health Record; Emergency Situation; Employment; Family; Frequencies; Funding; Health Care Costs; Health Personnel; Health system; Hybrids; Injury; Inpatients; Intervention; Interview; Marijuana; Medical; Medicine; Mental Depression; Mental Health; Mental Health Services; Modality; Morbidity - disease rate; Outcome; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Pediatrics; Persons; Population; Population Heterogeneity; Primary Health Care; Process; Provider; Psychiatry; Public Health; Quality of Care; Randomized; Reporting; Research; Resources; Risk; Sampling; Services; Speed; Structure; Suicide; Symptoms; Telemedicine; Telephone; Time; Tobacco; Training; Treatment Protocols; United States National Institutes of Health; Visit; World Health; addiction; adolescent alcohol and drug use; aged; alcohol and other drug; alcohol risk; alcohol use disorder; arm; base; behavioral health; brief intervention; comorbidity; comparative effectiveness; computerized; cost; cost effective; cost effectiveness; depressive symptoms; effectiveness implementation trial; evidence base; health service use; implementation barriers; implementation cost; implementation outcomes; implementation process; improved; improved outcome; informant; insight; medical specialties; mortality; pandemic disease; pediatrician; psychiatric comorbidity; routine care; screening; screening, brief intervention, referral, and treatment; service utilization; telehealth; treatment arm; vaping; virtual; virtual delivery; virtual screening

PROJECT SUMMARY/ABSTRACT Adolescent alcohol and other drug (AOD) use is a major public health concern posing significant challenges to healthcare providers, patients and families. It is associated with comorbid psychiatric and medical conditions, poor educational and employment outcomes, accidents and injuries, and avoidable health services utilization and costs (e.g., emergency and inpatient). Early AOD use initiation is associated with alcohol use disorders in adulthood. Screening, Brief Intervention and Referral to Treatment (SBIRT) delivered in pediatric primary care is an effective approach to early identification and intervention and can reduce both AOD use and consequences and co-occurring mental health symptoms, yet widespread implementation is lacking, due to a variety of barriers, including the time constraints and competing priorities faced by pediatricians and lack of trained staff. Research on efficient and cost-effective modalities of SBIRT delivery in pediatric primary care is critical to expanding the evidence base and supporting broader implementation. Accelerated by the pandemic, behavioral telemedicine approaches to addressing adolescent AOD use and mental health problems are gaining momentum and offer the potential to increase the reach and impact of SBIRT in pediatric primary care. This study’s objective is to examine whether a centralized, virtually delivered modality of SBIRT, rapidly accessible by multiple pediatric primary care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD and comorbid mental health problems among adolescents at high or severe risk of AOD use disorder . In this wholly pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation trial, set in a large, real-world health system with a highly diverse population, we will randomize 20 busy, general pediatric primary care clinics with an eligible population of approximately 22,320 12-17 year old adolescents, to one of two intervention arms: 1) clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health clinician (CV-SBIRT arm), or 2) clinics where appointment-based brief interventions are delivered by a behavioral health clinician assigned to the clinic (Traditional SBIRT arm). Licensed behavioral health clinicians in both arms will be trained in the same empirically supported SBIRT protocol, differing only in its modality of delivery. The sample will include all adolescents aged 12 through 17 years seen for a Well Visit, who are at high or severe risk of AOD use disorder defined as endorsing monthly or more frequent AOD use OR any AOD use and past-two-week depressive symptoms or suicidality. We will use administrative and clinical data collected in the electronic health record during routine care to compare SBIRT implementation (rates of brief interventions and referrals), AOD and mental health outcomes (use frequency and symptom endorsement and diagnoses), specialty Addiction Medicine and Psychiatry treatment initiation and engagement, health services use (inpatient and Emergency Department), and cost-effectiveness in the intervention arms, at 1 and 2 years post-screening.

项目总结/文摘