Harnessing telemedicine to improve alcohol use disorder outcomes in primary care patients

利用远程医疗改善初级保健患者酒精使用障碍的结果

• 批准号: 10628012
• 负责人: Erin E. Bonar
• 金额: $ 67.64万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10628012
• 关键词: Abstinence; Address; Adult; Alcohol consumption; Alcohols; COVID-19; COVID-19 pandemic; Caring; Cellular Phone; Chronic; Clinic; Clinical; Cognitive Therapy; Consensus; Evidence based treatment; Goals; Healthcare Systems; Heavy Drinking; Home; Infrastructure; Intervention; Location; Measures; Mediator; Medical; Mental Health; Mental disorders; Michigan; Modeling; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patients; Persons; Population; Primary Care; Provider; Public Health; Quality of life; Randomized; Recommendation; Recovery; Risk; Science; Socioeconomic Status; Strategic Planning; Substance Use Disorder; Telemedicine; Testing; Therapeutic Intervention; Videoconferencing; Work; addiction; alcohol effect; alcohol intervention; alcohol related consequences; alcohol risk; alcohol use disorder; alcohol-related death; care seeking; comparison intervention; design; drinking; effective therapy; efficacy evaluation; efficacy trial; evidence base; experience; follow-up; functional disability; functional improvement; improved; innovation; interest; intervention effect; medical specialties; mortality; motivational enhancement therapy; novel; patient engagement; prevent; primary care clinic; primary care patient; psychoeducation; psychoeducational; psychosocial; recruit; screening, brief intervention, referral, and treatment; social stigma; treatment as usual

Project Summary/Abstract Alcohol use disorder (AUD) is common and contributes to extensive functional impairments, morbidity and mortality. Evidence-based psychosocial treatments, in particular Cognitive Behavioral Therapies (CBT) and Motivational Interviewing (MI), are effective; but, fewer than 10% of people with AUD receive treatment. Prior efforts have focused on screening, brief intervention and referral to treatment (SBIRT) in primary care. However, referral has failed to increase treatment use due to barriers (e.g., poor treatment accessibility, stigma of specialty addiction clinics) causing referred patients not to seek care. In addition, patients who are typically non-treatment seeking (i.e., patients not presenting for AUD care) may vary in their drinking goals. Thus, new models of care to engage and deliver effective treatments across the spectrum of the large, dispersed population of AUD patients are critically needed. Telemedicine, specifically synchronous videoconferencing between providers and patients in separate locations, can potentially help increase treatment utilization by delivering care to patients at home and reducing stigma of attending treatment in specialty care settings. Telemedicine is effective for many conditions, but there have been no efficacy trials to date for AUD. Although limited telemedicine infrastructure has been a barrier in the past, the COVID-19 pandemic has proven that it can be rapidly implemented and widely used. There is an urgent need to determine if telemedicine delivered AUD treatment is efficacious to inform dissemination. Therefore, the objective of this study is to evaluate a telemedicine-delivered MI-CBT treatment intervention for AUD (MI-CBT TeleTx) compared to Enhanced Usual Care (EUC) on AUD treatment utilization and alcohol use. Primary care patients with AUD in two large healthcare systems in southeast Michigan will be recruited and randomized to either MI-CBT TeleTx or EUC. Specific Aims are: Aim 1: Determine the impact of providing the option of the TeleTx intervention (n=150) compared to EUC (n=150) in primary care patients with AUD on AUD treatment utilization. Aim 2: Determine the efficacy of the TeleTx intervention compared to EUC on percent drinking days and percent heavy drinking days across 3-, 6-, and 12-month follow-ups. Aim 3: Determine the effect of the TeleTx intervention on alcohol-related consequences and functioning (e.g., quality of life, mental health) and the moderating effect of alcohol risk level reductions. In addition, an exploratory aim is to determine key mediators of the effect of intervention on treatment use (through improved treatment accessibility and reduced stigma) and on alcohol use (through treatment use). Impact: The findings from this study will have a significant public health impact as a novel and scalable approach to address the large AUD treatment gap. Further, the work will be the first large efficacy trial of a telemedicine AUD intervention and test a new model of care designed to engage non-treatment seeking patients and deliver effective AUD treatment to patients outside of traditional specialty care settings.

项目总结/文摘