Leveraging virtual care strategies to improve access and treatment for individuals with alcohol use disorders

利用虚拟护理策略来改善酒精使用障碍患者的获取和治疗

• 批准号: 10615089
• 负责人: Erin E. Bonar
• 金额: $ 70.19万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10615089
• 关键词: Address; Administrator; Adoption; Adult; African American; African American population; Alcohol consumption; Alcohols; Black Populations; Black race; COVID-19; Caring; Chronic; Chronic Care; Clinic; Cognitive Therapy; Communities; Coping Skills; Cost Measures; Data; Enrollment; Ethnic Origin; Future; Health; Health Services Accessibility; Health system; Healthcare Systems; Heavy Drinking; Improve Access; Individual; Infrastructure; Intervention; Interview; Latinx; Life; Location; Measures; Mediator; Mental Health; Modeling; Motivation; Outcome; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Phase; Phototherapy; Population; Population Heterogeneity; Psychotherapy; Public Health; Race; Randomized; Readiness; Reduce health disparities; Resource Allocation; Resources; Risk Factors; Sampling; Sequential Multiple Assignment Randomized Trial; Stigmatization; System; Telephone; Testing; Therapeutic; Underrepresented Populations; Woman; Women' s Group; Work; adaptive intervention; addiction; alcohol abuse therapy; alcohol use disorder; barrier to care; care delivery; care seeking; cost; disparity reduction; drinking; effectiveness/implementation trial; efficacious treatment; evidence base; experience; future implementation; health care disparity; health disparity; hybrid type 1 design; implementation facilitators; improved; improved outcome; innovation; medical specialties; motivational enhancement therapy; novel; opioid misuse; outcome disparities; patient engagement; patient population; patient portal; prevent; recruit; reduced alcohol use; sex; social stigma; substance use; suicidal risk; telehealth; telephone session; theories; treatment disparity; treatment program; trial design; video session; virtual; virtual delivery; virtual healthcare

Project Summary/Abstract Despite the efficacy of psychotherapies, ~90% of people with alcohol use disorder (AUD) do not receive treatment for this chronic condition and there are notable disparities in care. Access to and involvement in efficacious AUD care is even lower for women, Black/African American individuals, and people from other under-represented groups. Novel virtual care approaches (telephone, video, portal therapies) conceptually rooted in efficacious therapies [e.g., motivational interviewing (MI), cognitive behavioral therapy (CBT)] and theory can potentially improve treatment accessibility and appeal and reduce stigma. Virtual approaches have had limited use in AUD care, recently increasing in COVID-19 to provide ongoing care (telephone/video therapy) for current patients in specialty clinics, while treatment initiation remains low. There is an untapped potential for virtual approaches to engage individuals across health systems, who otherwise do not receive treatment, but could benefit. Virtual strategies, including telephone and video sessions and patient portals, are promising for reaching and engaging substance-using populations, including under-represented individuals, within health systems. Using a portal messaging system and phone calls to virtually engage patients in AUD treatment outside of clinics and in their preferred locations is an innovative treatment model that can potentially be implemented in health systems, but must be tested to inform broader dissemination. We will use a sequential, multiple assignment randomized trial (SMART) to identify critical adaptive intervention (AI) strategies for a virtually-delivered AUD engagement and care model. Adults with AUD (50% women, 25% Black/African American, 5% Latinx) will be randomized to a 1st stage strategy for drinking reduction and AUD care engagement integrating referral for AUD care: 1) a single telephone MI session (T- engage), or 2) 4-weeks of a MI-focused portal messaging (P-engage). At 4 weeks, non-responders will be randomized to a 2nd stage strategy: 1) step up to a video 8-session MI-CBT for AUD (phone delivery as needed), or 2) continued 1st stage (i.e., 4 weeks of P-engage with greater depth, a second T-engage session building on the first). Outcomes will be assessed at 4-, 8-, and 12-months. Aim 1 will compare 1st-stage strategies (T-engage vs. P-engage) on alcohol outcomes and AUD treatment utilization. In Aim 2, among 1st- stage non-responders, we will identify the most efficacious 2nd-stage strategy. Aim 3 includes an implementation planning phase, with cost measures, and key stakeholder interviews and qualitative analysis of barriers and facilitators to implementation and adoption of a virtual care model. Secondary aims include: examining the moderating effects of race/ethnicity and sex on outcomes given our enriched sample and examining the best sequence of AIs. Our proposed project will have high public health impact by evaluating a novel virtual care model focused on increasing both treatment engagement and delivery that can be integrated in health systems to increase AUD treatment appeal and accessibility and help address treatment disparities.

项目概要/摘要 尽管心理治疗有效，但约 90% 的酒精使用障碍 (AUD) 患者并没有 接受这种慢性病的治疗，并且护理方面存在显着差异。接触和参与 对于女性、黑人/非裔美国人和其他人来说，有效的 AUD 护理的比例甚至更低 代表性不足的群体。从概念上讲，新颖的虚拟护理方法（电话、视频、门户疗法） 植根于有效的疗法[例如动机访谈（MI）、认知行为疗法（CBT）]和 理论可以潜在地提高治疗的可及性和吸引力，并减少耻辱。虚拟方法有 在 AUD 护理中的使用有限，最近在 COVID-19 中增加以提供持续护理（电话/视频 治疗）目前在专科诊所的患者，但治疗启动率仍然很低。有一个未开发的 虚拟方法有可能让卫生系统中的个人参与进来，否则他们将无法接受 治疗，但可能会受益。虚拟策略，包括电话和视频会话以及患者门户， 承诺接触和吸引药物滥用人群，包括代表性不足的个人， 卫生系统内。使用门户消息系统和电话以虚拟方式让患者参与 AUD 在诊所外和他们喜欢的地点进行治疗是一种创新的治疗模式，有可能 在卫生系统中实施，但必须进行测试，以便为更广泛的传播提供信息。 我们将使用序贯、多重分配随机试验 (SMART) 来确定关键的适应性 虚拟交付的 AUD 参与和护理模型的干预 (AI) 策略。成人澳元 (50% 女性（25% 黑人/非裔美国人，5% 拉丁裔）将被随机分配到第一阶段饮酒策略 减少和 AUD 护理参与结合 AUD 护理转介：1) 一次电话 MI 会话 (T- 参与），或 2） 4 周以 MI 为中心的门户消息传递（P-engage）。 4 周后，无反应者将被 随机分配到第二阶段策略：1) 升级到 8 节视频 MI-CBT，费用为澳元（电话交付为 需要），或 2) 继续第一阶段（即 4 周更深度的 P-engage，第二次 T-engage 疗程） 建立在第一个的基础上）。结果将在 4 个月、8 个月和 12 个月时进行评估。目标 1 将比较第一阶段 关于酒精结果和 AUD 治疗利用率的策略（T-engage 与 P-engage）。在目标 2 中，第 1- 对于阶段无反应者，我们将确定最有效的第二阶段策略。目标 3 包括 实施规划阶段，包括成本衡量、关键利益相关者访谈和定性分析 实施和采用虚拟护理模式的障碍和促进因素。次要目标包括： 鉴于我们丰富的样本和结果，检查种族/民族和性别对结果的调节作用 检查 AI 的最佳序列。我们提出的项目将通过评估对公共健康产生重大影响 新颖的虚拟护理模式专注于增加可集成的​​治疗参与度和交付 提高 AUD 治疗的吸引力和可及性，并帮助解决治疗差异。