Implementation Research for Evidence-based Care for Alcohol Dependence

酒精依赖循证护理实施研究

• 批准号: 8596229
• 负责人: Emily Caterina Williams
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8596229
• 关键词: Address; Agreement; Alcohol dependence; Alcohols; Behavior; Behavior Therapy; Biostatistical Methods; Care given by nurses; Caring; Case Manager; Clinical; Clinical Management; Data; Development; Disease; Doctor of Philosophy; Education; Effectiveness; Electronics; Ensure; Evaluation; FDA approved; Focus Groups; Goals; Grant; Guidelines; Health Care Costs; Health Personnel; Health Services; Improve Access; Institute of Medicine (U.S.); Intervention; Interview; K-Series Research Career Programs; Knowledge; Laboratories; Market Research; Medical; Mental Health; Mental Health Services; Mentorship; Methods; Monitor; Morbidity - disease rate; Naltrexone; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patients; Pharmaceutical Preparations; Primary Health Care; Provider; Qualitative Methods; Quality of Care; Research; Research Design; Research Methodology; Research Personnel; Research Training; Scientist; Secondary to; Series; Social Marketing; Strategic Planning; Structure; Substance Use Disorder; Surveys; System; Testing; Time; Training; Universities; Veterans; Washington; Writing; addiction; alcohol abuse therapy; alcohol behavior; alcohol misuse; arm; base; behavior change; brief intervention; career; cost; design; evidence base; experience; handbook; implementation research; implementation science; improved; innovation; interest; medical specialties; mortality; novel; primary care setting; professor; programs; public health relevance; skills; social stigma; sound; standard of care; theories; therapy design; tool

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.

描述(由申请人提供)： 背景资料。艾米丽·威廉姆斯，博士，公共卫生硕士，VA Puget Sound HSR&D的核心研究员，华盛顿大学卫生服务学助理教授。威廉姆斯博士致力于开展退伍军人研究，重点是改善酗酒退伍军人的获得机会和护理质量。拟议的职业发展奖将确保威廉姆斯博士发展必要的技能和专业知识，成为一名独立的卫生服务研究员，致力于改善对患有成瘾障碍的退伍军人的护理。职业发展计划。拟议的CDA专注于解决一种成瘾障碍-酒精依赖-这在退伍军人中很常见，而且治疗不足。虽然护理的标准是为酒精依赖患者提供转介到专门的成瘾治疗，但大多数人不去。因此，专家们一致认为，对酒精依赖的护理应该扩大到初级保健环境。虽然在专科环境中提供的许多行为治疗在初级保健中不能合理地提供，但有三种药物是FDA批准的用于治疗酒精依赖的，可以在初级保健中开出。因此，这些药物的可获得性是退伍军人管理局指南推荐的，优化它们的使用被描述为VHA统一精神卫生服务手册和物质使用障碍QUERI战略计划的目标。然而，大多数有酒依赖的退伍军人(~95%)没有得到这些药物，而且初级保健提供者给他们开处方可能有很多障碍。拟议的CDA研究旨在：1)描述退伍军人初级保健提供者治疗酒精依赖的障碍和促进者；2)开发和预先测试干预措施，为初级保健提供者在退伍军人初级保健中治疗酒精依赖做好准备；以及3)测试干预措施--在其他系统的背景下传播--为管理酒精依赖提供支持--对于增加单一退伍军人管理局酒精依赖药物的处方是否有效。这种干预将基于最先进的社会营销方法，并借鉴其他行为改变理论。计划中的研究使用一对一定性访谈、焦点小组、电子调查和应用于辅助VA临床和管理数据的高级中断时间序列设计。威廉姆斯博士将获得进行这项拟议研究的经验，同时还将接受酒精依赖和行为改变理论的结构化培训，以及实施科学、先进方法、研究设计和拨款撰写方面的培训。威廉姆斯博士将在退伍军人管理局实施研究的前沿专家(凯瑟琳·布拉德利医学博士；亚历克斯·索克斯-哈里斯博士)、生物统计学和定性方法(分别为安德鲁·周博士和杰夫·柯伦博士)、退伍军人管理局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·卢德曼博士)和社会营销(迈克尔·西格尔医学博士、公共卫生硕士和马克·福汉德博士)专家的指导下进行研究和培训。冲击力。这一CDA将使威廉姆斯博士能够与退伍军人管理局的领导人合作，针对酒精依赖的高质量护理方面的一个重要且可衡量的差距进行研究。此外，它将在以下方面提供有系统的培训和指导 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转型为一名独立的卫生服务研究人员，他的职业生涯将改善对患有成瘾障碍的退伍军人的护理。