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/摘要 青少年酒精和其他药物的使用是一个重大的公共卫生问题， to healthcare医疗providers提供者，patients患者and families家庭.它与精神病和医学共病有关， 教育和就业结果不佳，事故和伤害，以及可避免的卫生服务利用 和成本（例如，急诊和住院）。早期开始使用AOD与酒精使用障碍相关， 成年在儿科初级保健中提供筛查、短暂干预和转诊治疗（SBIRT） 是及早识别和介入的有效方法，并可减少使用爆炸品及减低爆炸品的后果 和共同发生的精神健康症状，但由于各种障碍， 包括时间限制和儿科医生面临的竞争优先事项以及缺乏训练有素的工作人员。研究 在儿科初级保健中提供有效和具有成本效益的SBIRT模式对于扩大 证据基础和支持更广泛的实施。大流行加速了行为远程医疗 解决青少年使用AOD和心理健康问题的方法正在获得动力，并提供 有可能增加SBIRT在儿科初级保健中的覆盖范围和影响。这项研究的目的是检查 无论是一种集中的、虚拟提供的SBIRT模式， 护理诊所，可以成本效益地实施，以改善早期识别和治疗急性阻塞性肺病， AOD使用障碍高或严重风险青少年中的共病心理健康问题在这整个 务实的，类型1混合比较有效性实施试验，设置在一个大型的，现实世界的健康 系统具有高度多样化的人口，我们将随机选择20个忙碌的普通儿科初级保健诊所， 约22，320名12-17岁青少年的合格人群，分为两个干预组之一：1） 在这些诊所中，由一个集中的行为健康中心通过视频或电话虚拟地提供简短的干预措施， 临床医生（CV-SBIRT组），或2）由 分配到诊所的行为健康临床医生（传统SBIRT组）。持牌行为健康 两组的临床医生都将接受相同的经验支持SBIRT方案的培训，不同之处仅在于其 交付方式。样本将包括所有12至17岁的青少年，接受健康访视， 有很高或严重的AOD使用障碍风险，定义为每月或更频繁地使用AOD或任何 AOD使用与过去两周的抑郁症状或自杀倾向。我们将使用管理和临床数据 在常规护理期间收集电子健康记录中的数据，以比较SBIRT的实施情况（简短的 干预和转诊），AOD和心理健康结果（使用频率和症状认可， 诊断），专业成瘾医学和精神病学治疗的启动和参与，卫生服务 1年和2年时干预组的使用（住院和急诊科）和成本效益 筛选后。