Computer vs Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care

计算机与治疗师对初级保健中药物滥用提供的简短干预

• 批准号: 7814806
• 负责人: DACE S SVIKIS
• 金额: $ 61.24万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7814806
• 关键词: Address; Adolescent; Adopted; Adult; Alcohol abuse; Alcohol or Other Drugs use; Alcohols; American; Benchmarking; Cessation of life; Clinic; Clinical; Communities; Computers; Consent; Control Groups; Country; Data; Disease; Drug usage; Economic Burden; Economics; Effectiveness; Employment Opportunities; Enrollment; Exercise; Funding; Gold; Grant; Hand; Health; Health Services Accessibility; Health Surveys; Illicit Drugs; Information Resources; Informed Consent; Internal Medicine; Intervention; Investments; Life; Lobbying; Measures; Medical; Methods; Minor; Moods; Morbidity - disease rate; Motivation; Organ; Outcome; Outpatients; Parents; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physicians; Population; Population Heterogeneity; Practice Guidelines; Primary Health Care; Professional counselor; Public Health; Randomized; Recovery; Recruitment Activity; Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Screening procedure; Sleep; Smoke; Smoker; Software Engineering; Stress; Substance Use Disorder; Substance abuse problem; Surgeon; Surveys; System; Technology; Text; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Toxicology; Training; Translations; United States; United States National Institutes of Health; Urine; Visit; Woman; aged; alcohol screening; base; brief intervention; brief motivational intervention; cigarette smoking; clinical efficacy; clinical practice; computerized; cost; cost effectiveness; disability; drug abuse brief intervention; economic cost; economic implication; economic outcome; effective intervention; effective therapy; follow-up; group intervention; health economics; improved; meetings; mortality; motivational intervention; nutrition; parent grant; prenatal smoking; programs; psychosocial; public health relevance; response; routine practice; screening and brief intervention; screening, brief intervention, referral, and treatment; smoking cessation; smoking intervention; standard care; tobacco abstinence

DESCRIPTION (provided by applicant): To distinguish between the parent R01 grant and the competitive revision (CS), information relevant to the parent grant is shown in standard text format. Information relevant to the competitive supplementary revision (CS) is shown in italics. The current application is submitted in response to NOT-OD-09-058 ("NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications"). The parent grant (R01DA026091-01; "Computer vs. Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care") was funded 9/08 in response to DA 08-021 (SBIRT in medical settings). Briefly, the rationale and methods for the parent study are as follows: The vast majority of persons with substance use disorders go undetected and untreated. Proactive screening, brief intervention, and referral for treatment approaches (SBIRT) have tremendous potential for identifying and influencing undetected substance abuse, but efforts to incorporate them in the community have met with substantial obstacles related to training, time, costs, and acceptance. Computer-delivered approaches, on the other hand, are a promising alternative and merit serious consideration, as they have shown beneficial effects on substance use outcomes (e.g., Hester et al., 2005; Ondersma, Svikis & Schuster, 2007). These approaches also have tremendous advantages in terms of replicability, accessibility, and cost. The parent R01 grant identifies primary care patients at risk for heavy/problem alcohol and drug use through a 15-minute, computer-delivered health screen (Health Cheq) that queries patients about nutrition, exercise, sleep and mood as well as alcohol, tobacco and other drug use. Persons who screen at risk for heavy/problem substance use and provide informed consent (N=680) are randomized to one of 4 groups: computer-delivered health screen alone (standard care, SC), assessment only (CA), assessment plus computer-delivered brief motivational intervention (CACI), or assessment plus therapist-delivered brief motivational intervention (CATI). Outcomes (substance use via self- report and urine toxicology) are compared at 1, 3, and 6 months post-randomization. A sophisticated economic analysis will also be performed to compare costs for computer and counselor-delivered interventions. The impetus and rationale for the competitive supplementary revision (CS) are as follows: While the computer-delivered Health Cheq screens for tobacco use, the parent grant does not specifically target cigarette smoking for intervention. This was disappointing to clinicians in the target clinic who report that over one-third (35%) of their patients smoke cigarettes and little is currently being done to address this problem. Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general (Surgeon General's Report, 2004). The 2008 Practice Guidelines for Treating Tobacco Dependence identifies the 5 A's (Ask, Advise, Assess, Assist, Arrange) as the most promising practitioner-delivered intervention. As with SBIRT above, however, numerous barriers to incorporating the 5 A's intervention into routine clinical practice have been reported (Fiore et al., 2008). This competitive supplement (CS) makes convenient use of the infrastructure already in place through the parent grant to collect benchmark data on the effectiveness of a computer-delivered 5A's intervention for cigarette smoking. The computerized 5A's intervention already exists for prenatal smoking (R21, Ondersma & Svikis). With minor revisions it can be studied in the competitive supplement project. Specifically, the proposed research will compare 1- and 3-month smoking cessation rates in medical patients (N=380) randomized to the computer-delivered 5A intervention or a screening + resource information control group. The CS proposal will not only provide additional employment opportunities for research assistants, it will also increase the rate and number of subjects recruited for the parent grant and provide greater power for secondary analyses. Most importantly, it will inform the field about the efficacy of a computer-delivered 5 A's intervention with both clinical and economic analyses. If outcomes are comparable to those reported in previous practitioner-delivered research, the practical and economic implications of its use will be significant and should ultimately reduce tobacco mortality and morbidity rates in this country. PUBLIC HEALTH RELEVANCE: Although a physician-delivered 5A's approach to smoking cessation is considered the "gold standard" among researchers, the extent to which this intervention has been adopted in routine practice settings is sadly lacking. This competitive supplement will collect benchmark data on smoking cessation rates when the 5A's intervention is delivered entirely via computer-based technology. If outcomes are comparable to those reported in the 2008 practice guidelines for tobacco cessation and better than those found in standard care, the findings would have major practical and economic implications, ultimately assisting more patients in their efforts to stop smoking. This CS interfaces perfectly with the parent R01, which targets heavy/problem alcohol and/or drug use and compares 2 greatly simplified, computer-based approaches to screening and brief intervention to a more traditional, counselor-delivered MI intervention. If one or both of the computer-based approaches yields outcomes comparable to the usual counselor-delivered approach, the simplicity of the computer-based technology would make treatment available to many more persons with drug or alcohol problems as well.

描述（由申请人提供）： 为了区分父R 01授权和竞争修订版（CS），与父授权相关的信息以标准文本格式显示。与竞争性补充修订版（CS）相关的信息以斜体显示。当前申请是为了响应NOT-OD-09-058（“NIH宣布为竞争性修订申请提供恢复法案资金”）而提交的。父母补助金（R 01 DA 026091 -01;“计算机与治疗师对初级保健中药物滥用的简短干预”）于2008年9月根据DA 08-021（医疗环境中的SBIRT）获得资助。 简言之，母研究的原理和方法如下：绝大多数物质使用障碍患者未被发现和治疗。主动筛查、简短干预和转诊治疗方法（SBIRT）在识别和影响未被发现的药物滥用方面具有巨大的潜力，但将其纳入社区的努力遇到了与培训、时间、成本和接受有关的重大障碍。另一方面，计算机提供的方法是一种很有前途的替代办法，值得认真考虑，因为它们对药物使用的结果显示出有益的影响（例如，Hester等人，2005; Ondersma，Svikis & Schuster，2007）。这些方法在可复制性、可获得性和成本方面也有巨大的优势。父R 01补助金通过15分钟的计算机提供的健康屏幕（Health Cheq）识别有严重/问题酒精和药物使用风险的初级保健患者，该屏幕询问患者的营养，运动，睡眠和情绪以及酒精，烟草和其他药物使用。筛选重度/问题物质使用风险并提供知情同意书的人（N=680）被随机分为4组：仅计算机提供的健康筛查（标准治疗，SC），仅评估（CA），评估加计算机提供的简短动机干预（CACI），或评估加治疗师提供的简短动机干预（CATI）。在随机化后1、3和6个月比较结局（通过自我报告和尿液毒理学的物质使用）。还将进行一项复杂的经济分析，以比较计算机和咨询人员提供的干预措施的成本。 竞争性补充修订（CS）的动力和理由如下：虽然计算机提供的健康检查筛查烟草使用，但父母补助金并没有专门针对吸烟进行干预。这令目标诊所的临床医生感到失望，他们报告说，超过三分之一（35%）的患者吸烟，目前几乎没有采取措施解决这个问题。吸烟几乎损害身体的每一个器官，导致许多疾病，并降低吸烟者的健康（卫生部长报告，2004年）。2008年《烟草依赖治疗实践指南》将5A（询问、建议、评估、协助、安排）确定为最有希望的烟草依赖治疗干预措施。然而，与上述SBIRT一样，已经报道了将5A干预纳入常规临床实践的许多障碍（Fiore等人，2008年）。这种竞争性补充（CS）可以方便地使用通过父母补助金已经到位的基础设施，以收集计算机提供的5A吸烟干预措施有效性的基准数据。计算机化的5A干预已经存在于产前吸烟（R21，Ondersma和Svikis）。经过小的修改，它可以在竞争性补充项目中进行研究。具体而言，拟议的研究将比较随机分配到计算机提供的5A干预或筛选+资源信息对照组的医学患者（N=380）的1个月和3个月戒烟率。CS建议不仅会为研究助理提供额外的就业机会，还将增加父母补助金招募的受试者的比例和数量，并为二次分析提供更大的权力。最重要的是，它将通过临床和经济分析告知该领域计算机提供的5A干预的有效性。如果结果与以前的烟草商交付的研究报告的结果相当，其使用的实际和经济影响将是显着的，并应最终降低烟草死亡率和发病率在这个国家。 公共卫生相关性：虽然医生提供的5A戒烟方法被认为是研究人员的“黄金标准”，但在常规实践环境中采用这种干预措施的程度令人遗憾。当5A的干预完全通过基于计算机的技术提供时，这种竞争性补充将收集戒烟率的基准数据。如果结果与2008年戒烟实践指南中报告的结果相当，并且优于标准护理中发现的结果，则研究结果将具有重大的实际和经济意义，最终帮助更多的患者努力戒烟。该CS与父R 01完美对接，其针对重度/问题酒精和/或药物使用，并将2种大大简化的基于计算机的筛查和简短干预方法与更传统的顾问提供的MI干预进行比较。如果一种或两种基于计算机的方法产生的结果与通常的咨询方法相当，基于计算机的技术的简单性也将使更多的吸毒或酗酒者获得治疗。