Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery

描述（由申请人提供）：尽管在急诊科（ed）就诊的患者中有很大比例存在饮酒风险或问题，但很少有人接受筛查并接受旨在帮助他们减少或停止饮酒的简短干预（BI）等服务。可能是由于可行性方面的挑战，如培训员工、监测保真度和维护系统以确保长期实施，急诊部门并不经常提供BIs。已发现酒精性BIs在各种卫生保健环境中是有效和有效的。然而，在急诊科中使用它们的证据褒贬不一。在这种快节奏和广泛使用的环境中，迫切需要制定有效的策略来筛查和最佳地提供酒精性脑卒中。现有的临床医生交付的BI策略需要修改，以便它们能够标准化和高保真地管理，并且对急诊科人员的时间和资源要求最低。计算机提供的BIs是解决在这种和其他医疗保健环境中提供干预措施所固有挑战的一种方法。这项拟议中的研究将通过带有音频的触摸屏电脑平板电脑进行计算机筛查，招募750名筛查呈阳性的内城ED患者，这些患者有饮酒风险或问题。年龄在18-60岁的参与者将被随机分配到以下三种情况之一：1)计算机提供的简短干预（C-BI, n=250）；2)治疗师提供的简短干预（T-BI, n=250）；3)加强日常护理（EUC; n=250）。所有参与者将收到有关社区资源的书面信息；符合酒精滥用/依赖标准的个人也将接受酒精治疗转诊。分层随机分配[按性别；满足酒精使用障碍的标准（是/否）将作为所有条件的基线。本研究的目的是开发和完善量身定制的动机简短干预措施，这些干预措施在结构上是平行的，但对有风险或有问题的酒精使用患者有不同的交付方式（计算机vs.治疗师），并进行一项随机对照试验，比较这些BI方法（C-BI, T-BI，对照）对随后的酒精消费和酒精后果的疗效，包括酒精相关损伤、精神和身体健康功能。在ed访问后3、6和12个月的HIV风险行为。对治疗师和计算机提供的BIs（包括潜在的调节者和调解者）的疗效进行严格的检查，将解决先前试验提出的关键限制，并将确定在该地点广泛实施短暂酒精干预的最佳方式。由于急诊科是进入医疗保健系统的重要门户，特别是对市中心的病人来说，提供有效的酒精BIs，强调关键的动机访谈成分，并最大限度地减少人力资源，可能会对公共卫生产生重大影响。

DESCRIPTION (provided by applicant): Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or problem alcohol use, few are screened and receive services such as brief interventions (BI) designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious and effective in a variety of health care settings. However, the evidence for their use in the ED has been mixed. There is a pressing need to develop efficacious strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing clinician-delivered BI strategies need to be modified so that they can be standardized and administered with high fidelity and minimal demands on ED staff time and resources. Computer-delivered BIs are one method to address the challenges inherent in delivering interventions in this and other healthcare settings. The proposed study will use computerized screening via touch-screen computer tablets with audio to recruit 750 inner-city ED patients screening positive for at-risk or problem alcohol use. Participants age 18-60 will be randomized to one of three conditions: 1) Computer-delivered brief intervention (C-BI; n=250); 2) Therapist-delivered brief intervention (T-BI; n=250); or 3) Enhanced usual care (EUC; n=250). All participants will receive written information regarding community resources; individuals who meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals. Stratified random assignment [by gender; meeting criteria for an alcohol use disorder - yes/no] will take place at baseline for all conditions. The aims of the study are to develop and refine tailored motivational brief interventions that are parallel in structure but have varied delivery modalities (computer vs. therapist) for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled trial comparing the efficacy of these BI approaches (C-BI, T-BI, control) on subsequent alcohol consumption and alcohol consequences, including alcohol-related injury, mental and physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit. The rigorous examination of the efficacy of therapist- vs. computer- delivered BIs, including potential moderators and mediators, will address the key limitations raised by previous trials and will determine the optimal modality for wide implementation of brief alcohol interventions in this venue. Because the ED is such an important portal for entry into the medical care system, particularly for inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational interviewing components and minimize staff resources could have a major public health impact. PUBLIC HEALTH RELEVANCE: Few people who misuse alcohol and who might benefit from brief motivational interventions actually receive them. The inner city Emergency Department (ED) is an ideal location in which to implement screening, brief interventions, and referral to treatment, where needed, for alcohol misuse because of the heterogeneous proportion of patients in these settings who misuse alcohol.