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.

项目总结/文摘