Implementation Research for Evidence-based Care for Alcohol Dependence

描述（由申请人提供）： 背景艾米丽威廉姆斯，博士，公共卫生硕士是在弗吉尼亚州普吉特湾HSR&D的核心研究员和卫生服务助理教授在华盛顿大学。威廉姆斯博士已表明致力于进行退伍军人管理局的研究，重点是改善获得和护理质量的退伍军人与酒精滥用。拟议的职业发展奖将确保威廉姆斯博士将发展必要的技能和专业知识，成为一个独立的卫生服务研究人员，致力于改善护理退伍军人与成瘾性疾病。职业发展拟议中的CDA侧重于解决一种成瘾性疾病-酒精依赖-这是常见的和治疗不足的退伍军人。虽然护理标准是为酒精依赖患者提供特殊专业成瘾治疗，但大多数人并不去。因此，专家们一致认为，对酒精依赖的护理应扩大到初级保健机构。虽然许多在专业环境中提供的行为治疗不能合理地在初级保健中提供，但有三种药物是FDA批准用于治疗酒精依赖的，可以在初级保健中开具处方。因此，VA指南建议提供这些药物，并将优化其使用描述为VHA统一精神卫生服务手册和物质使用障碍QUERI战略计划中的目标。然而，大多数有酒精依赖的退伍军人（约95%）没有接受他们，初级保健提供者开处方可能有许多障碍。拟议的CDA研究旨在：1）描述VA初级保健提供者治疗酒精依赖的障碍和促进因素; 2）开发和预测试干预措施，以准备初级保健提供者在VA初级保健中治疗酒精依赖;和3）测试在其他系统层面支持酒精依赖管理的背景下传播的干预措施是否-有效增加单一VA机构的酒精依赖药物处方。干预措施将根据最先进的社会营销方法和其他行为改变理论制定。计划中的研究采用一对一的定性访谈，焦点小组，电子调查和先进的中断时间序列设计应用于二级VA临床和管理数据。威廉姆斯博士将获得的经验进行拟议的研究将补充结构化培训酒精依赖和行为改变理论，以及实施科学，先进的方法，研究设计，并授予写作。威廉姆斯博士将进行研究和培训的指导下，专家在最前沿的退伍军人管理局实施研究成瘾（凯瑟琳布拉德利，医学博士，公共卫生硕士; Alex Sox-Harris博士），生物统计学和定性方法（Andrew Zhou，PhD和Geoff Curran，PhD），在VA中使用药物治疗酒精依赖（大卫奥斯林，医学博士，公共卫生硕士），行为干预（埃维特Ludman，博士）和社会营销（迈克尔西格尔，医学博士，公共卫生硕士和马克Forehand，博士）。冲击该CDA将使威廉姆斯博士能够与退伍军人事务部的领导者合作，开展针对酒精依赖高质量护理中一个重要且可衡量的差距的研究。此外，它还将提供以下方面的结构化培训和指导： 实施科学和分析实施研究的先进方法。这些经验将确保威廉姆斯博士成功过渡到成为一个独立的卫生服务研究人员，其职业生涯将改善与成瘾性疾病的退伍军人的护理。

DESCRIPTION (provided by applicant): BACKGROUND. Emily Williams, PhD, MPH is a Core Investigator at VA Puget Sound HSR&D and an Assistant Professor in Health Services at the University of Washington. Dr. Williams has demonstrated a commitment to conducting VA research focused on improving access to and quality of care for Veterans with alcohol misuse. The proposed career development award will ensure that Dr. Williams will develop the skills and expertise necessary to become an independent health services researcher dedicated to improving care for Veterans with addictive disorders. CAREER DEVELOPMENT PLAN. The proposed CDA is focused on addressing one addictive disorder- alcohol dependence-which is common and undertreated among Veterans. While the standard of care is to offer patients with alcohol dependence referral to special specialty addictions treatment, most do not go. Therefore, experts agree that care for alcohol dependence should be expanded to primary care settings. While many of the behavioral treatments that are offered in specialty settings cannot reasonably be delivered in primary care, three medications are FDA-approved for treating alcohol dependence and can be prescribed in primary care. Thus, availability of these medications is recommended by VA guidelines, and optimizing their use is described as a goal in the VHA Handbook on Uniform Mental Health Services and the Substance Use Disorders QUERI Strategic Plan. However, most Veterans with alcohol dependence (~95%) do not receive them, and there are likely many barriers to primary care providers' prescribing them. The proposed CDA research aims to: 1) describe barriers and facilitators to VA primary care providers' treating alcohol dependence; 2) develop and pre-test an intervention to prepare primary care providers to treat alcohol dependence in VA primary care; and 3) test whether the intervention-disseminated in the context of other systems-level supports for management of alcohol dependence-is effective for increasing prescriptions for alcohol dependence medications at a single VA facility. The intervention will be developed based on state-of- the-art social marketing methods and informed by other behavior change theories. The planned research uses one-on-one qualitative interviews, focus groups, electronic surveys, and advanced interrupted time series design applied to secondary VA clinical and administrative data. The experience Dr. Williams will gain conducting the proposed research will be supplemented with structured training in alcohol dependence and behavior change theory, as well as implementation science, advanced methods, study design, and grant writing. Dr. Williams will conduct the research and training under the mentorship of experts at the forefront of VA implementation research on addictions (Katharine Bradley, MD, MPH; Alex Sox-Harris, PhD), biostatistical and qualitative methods (Andrew Zhou, PhD and Geoff Curran, PhD, respectively), use of medications to treat alcohol dependence in the VA (David Oslin, MD, MPH), behavioral interventions (Evette Ludman, PhD) and social marketing (Michael Siegel, MD, MPH and Mark Forehand, PhD). IMPACT. This CDA will allow Dr. Williams to collaborate with leaders in the VA to conduct research aimed at an important and measureable gap in high-quality care for alcohol dependence. Further, it will provide structured training and mentorship in implementation science and advanced methods for analyzing implementation research. Together these experiences will ensure Dr. Williams's successful transition to becoming an independent health services researcher whose career will improve the care of Veterans with addictive disorders.