Comparative Effectiveness and Feasibility of SBIRT in a General Dental Clinic

描述(由申请人提供)：(摘要)“SBIRT在普通牙科诊所的有效性和可行性比较”阐述了广泛的挑战领域，(05)比较有效性研究和具体挑战主题，05-DE-102：牙科环境中烟草和药物依赖的治疗。该方案描述了一项为期两年的随机对照试验，旨在实现两个主要目标：1)评估单独和以联合形式提供烟草和其他精神活性物质使用的筛查、简短干预和转介服务(SBIRT)的短期有效性；2)评估在社区普通牙科环境中对高危物质使用患者实施SBIRT的可行性。这项研究将为一项更雄心勃勃的临床试验提供基础，该试验将在多个牙科环境中进行，并包括更长的随访期。为了实现目标1,175名吸烟者和高危药物使用者(包括高危酒精使用者)将从康涅狄格大学健康中心的普通牙科诊所招募。研究人员将使用世界卫生组织开发的酒精、吸烟和物质参与筛查测试(ASSIST)来确定符合条件的患者。参与者将被随机分为三个实验条件之一：1)只吸烟的短暂干预组；2)吸烟的其他物质使用短暂干预组；或3)包括一般牙科健康咨询在内的等待名单控制条件。那些被分配到“积极”治疗条件的人将被给予简短的干预，将患者的筛查评估数据与与仅吸烟或烟草其他物质使用相关的牙科风险因素联系起来。参与者将在随机化后12周重新接受访谈，以使用定量和定性访谈方法评估结果和过程措施。关于目标2，这一机会的时机和这项临床试验的实施提供了一个独特的机会，可以跟踪两组牙科住院医师，以检查SBIRT住院医师培训对后续临床实践的影响。第一批人在研究开始时已经在工作人员中，将不会接受作为住院要求的一部分的SBIRT培训。第二批住院医生将接受为期三个小时的SBIRT培训，以补充2010年7月的住院要求。虽然不会要求居民为随机研究提供简短的干预措施，但将鼓励他们加强研究人员提供的信息。将衡量两组人在态度、知识和参与SBIRT计划活动的意愿方面的差异。围绕SBIRT概念组织的转化研究有了显著的增长，进行了大量的临床试验，开发了新的筛查测试，并对实施方案进行了评估，以确定SBIRT在初级保健和其他医疗环境中的可行性。尽管SBIRT与预防牙科病理有明显的相关性，但很少有人关注它的可行性、有效性及其在牙科环境中的实施情况。我们相信，现在是一个真正的研究机会，不仅可以评估SBIRT对牙科患者的有效性，还可以改进技术，使口腔健康从业者能够自信地对烟草、酒精和其他物质的高危使用者进行筛查、短暂干预和转介。本申请中描述的研究可能对临床科学和公共卫生牙科都具有重要意义。

DESCRIPTION (provided by applicant): (Abstract) "Comparative Effectiveness and Feasibility of SBIRT in a General Dental Clinic" addresses the broad Challenge Area, (05) Comparative Effectiveness Research and specific Challenge Topic, 05-DE-102: Treatment of tobacco and drug dependence in dental settings. This protocol describes a 2-year, randomized controlled trial designed to achieve two primary aims: 1) to evaluate the short-term effectiveness of screening, brief intervention and referral services (SBIRT) for tobacco and other psychoactive substance use when delivered separately and in combined forms and 2) to evaluate the feasibility of implementing SBIRT for patients with at-risk substance use in a community general dental setting. This research will provide the basis for a more ambitious clinical trial that would be conducted in multiple dental settings and include a longer follow-up period. To achieve Aim 1, 175 patients who are smokers and at-risk substance users (including at-risk alcohol users) will be recruited from the general dentistry clinic at the University of Connecticut Health Center. Research staff will use the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization, to identify eligible patients. Participants will be randomized to one of three experimental conditions: 1) a smoking-only brief intervention group; 2) a smoking + other substance use brief intervention group; or 3) a wait-list control condition that includes general dental health counseling. Those assigned to the "active" treatment conditions will be given a brief intervention that will link the patient's screening assessment data with dental risk factors associated with tobacco only or tobacco + other substance use. Participants will be re- interviewed at 12-weeks post randomization to assess outcome and process measures using a combination of quantitative and qualitative interviewing methods. Regarding Aim 2, the timing of this opportunity and implementation of this clinical trial provides a unique opportunity to follow two cohorts of dental residents to examine the impact of SBIRT residency training on subsequent clinical practice. The first cohort will already be on staff when the study begins and will not have received SBIRT training as part of the residency requirements. The second cohort of residents will be exposed to a three-hour SBIRT training session that will supplement the residency requirements for July, 2010. Although residents will not be asked to provide the brief interventions for the randomized study, they will be encouraged to reinforce the information delivered by research staff. Differences between the two cohorts with regard to attitudes, knowledge and willingness to engage in SBIRT program activities will be measured. There has been a remarkable growth in translational research organized around the SBIRT concept, with numerous clinical trials conducted, new screening tests developed, and implementation programs evaluated to determine the feasibility of SBIRT in primary care and other medical settings. Despite the obvious relevance of SBIRT to the prevention of dental pathology, there has been little attention to the determination of its feasibility, effectiveness and implementation in dental settings. We believe there is now a real research opportunity to not only evaluate the effectiveness of SBIRT with dental patients, but also to improve the technology so that oral health practitioners can feel confident conducting screening, brief intervention and referrals for at-risk users of tobacco, alcohol and other substances. The research described in this application could have significant implications on both clinical science and public health dentistry.