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。 MPH博士Emily Williams是VA Puget Sound Hsr＆D的核心调查员，也是华盛顿大学卫生服务助理教授。威廉姆斯博士表现出致力于进行VA研究的承诺，致力于改善滥用酒精的退伍军人的获得和护理质量。拟议的职业发展奖将确保威廉姆斯博士将发展成为一名独立卫生服务研究人员所必需的技能和专业知识，致力于改善成瘾性疾病的退伍军人的护理。职业发展计划。拟议的CDA专注于解决一种成瘾性疾病 - 酒精依赖性 - 在退伍军人中很常见且未治疗。虽然护理标准是为酒精依赖的患者转介到特殊的特种成瘾治疗方案中，但大多数都没有。因此，专家同意，应将对酒精依赖的护理扩展到初级保健环境。虽然在专业环境中提供的许多行为治疗无法合理地在初级保健中提供，但三种药物是FDA批准用于治疗酒精依赖的，可以在初级保健中开处方。因此，VA指南建议使用这些药物的可用性，优化其使用被描述为VHA统一心理健康服务手册和药物使用障碍QUERI战略计划的目标。但是，大多数具有酒精依赖的退伍军人（〜95％）没有收到他们，并且可能有许多初级保健提供者处方的障碍。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）制定和预测试干预措施，准备初级保健提供者，以治疗VA初级保健中的酒精依赖； 3）测试在其他系统级支持酒精依赖的背景下进行的干预措施是否有效 - 有效地增加了单个VA设施的酒精依赖药物处方。干预措施将基于最先进的社会营销方法制定，并由其他行为改变理论所告知。计划的研究使用一对一的定性访谈，焦点小组，电子调查以及高级中断的时间序列设计，适用于次要VA临床和行政数据。威廉姆斯博士将获得进行拟议的研究的经验，将补充酒精依赖和行为变化理论的结构化培训，以及实施科学，高级方法，研究设计和授予写作。威廉姆斯博士将在专家的指导下进行研究和培训。干预措施（Evette Ludman，PhD）和社会营销（医学博士Michael Siegel，MPH和Mark Fiphand，PhD）。影响。该CDA将允许威廉姆斯博士与弗吉尼亚州的领导人合作，进行针对高质量护理中对酒精依赖的重要差距的研究。此外，它将提供结构化的培训和指导 实施科学和用于分析实施研究的高级方法。这些经验将确保威廉姆斯博士成功过渡成为一名独立的卫生服务研究人员，其职业将改善患有上瘾疾病的退伍军人的照顾。