Harnessing telemedicine to improve alcohol use disorder outcomes in primary care patients

项目总结/摘要 酒精使用障碍（AUD）是常见的，并有助于广泛的功能障碍，发病率 and mortality.循证心理治疗，特别是认知行为疗法（CBT） 和动机访谈（MI）是有效的;但是，只有不到10%的AUD患者接受治疗。 先前的努力集中在初级保健中的筛查、短暂干预和转诊治疗。 然而，由于存在障碍（例如，治疗可及性差，污名化 专业成瘾诊所）导致转诊患者不寻求治疗。此外，典型的 不寻求治疗（即，不接受AUD治疗的患者）的饮酒目标可能不同。因此，新 护理模式，以参与和提供有效的治疗，在整个频谱的大，分散， AUD患者群体是急需的。 远程医疗，特别是提供者和患者之间的同步视频会议， 地点，可以通过在家中为患者提供护理， 在专科护理机构接受治疗的耻辱感。远程医疗对许多情况都有效，但 到目前为止，还没有关于AUD的疗效试验。虽然有限的远程医疗基础设施一直是一个障碍， 过去，COVID-19大流行已经证明它可以迅速实施和广泛使用。有一个 迫切需要确定远程医疗提供的AUD治疗是否能有效地告知传播。 因此，本研究的目的是评估远程医疗提供的MI-CBT治疗干预， AUD（MI-CBT TeleTx）与增强型糖尿病护理（EUC）在AUD治疗利用率和酒精使用方面的比较。 将招募密歇根州东南部两个大型医疗保健系统中患有AUD的初级保健患者， 随机分配至MI-CBT TeleTx或EUC。具体目标是： 目标1：确定提供TeleTx干预选项（n=150）与 接受AUD治疗的AUD初级保健患者的EUC（n=150）。目标2：确定 Teletx干预与EUC相比，在3-， 6个月和12个月随访。目标3：确定Teletx干预对酒精相关性 后果和功能（例如，生活质量、心理健康）和酒精风险的调节作用 水平降低。此外，一个探索性的目的是确定干预效果的关键介质， 治疗使用（通过改善治疗的可及性和减少耻辱）和酒精使用（通过 治疗用途）。影响：这项研究的结果将对公共卫生产生重大影响， 可扩展的方法来解决AUD治疗的巨大差距。此外，这项工作将是第一个大型功效试验， 远程医疗AUD干预和测试一种新的护理模式， 患者，并为传统专业护理环境之外的患者提供有效的AUD治疗。

Project Summary/Abstract Alcohol use disorder (AUD) is common and contributes to extensive functional impairments, morbidity and mortality. Evidence-based psychosocial treatments, in particular Cognitive Behavioral Therapies (CBT) and Motivational Interviewing (MI), are effective; but, fewer than 10% of people with AUD receive treatment. Prior efforts have focused on screening, brief intervention and referral to treatment (SBIRT) in primary care. However, referral has failed to increase treatment use due to barriers (e.g., poor treatment accessibility, stigma of specialty addiction clinics) causing referred patients not to seek care. In addition, patients who are typically non-treatment seeking (i.e., patients not presenting for AUD care) may vary in their drinking goals. Thus, new models of care to engage and deliver effective treatments across the spectrum of the large, dispersed population of AUD patients are critically needed. Telemedicine, specifically synchronous videoconferencing between providers and patients in separate locations, can potentially help increase treatment utilization by delivering care to patients at home and reducing stigma of attending treatment in specialty care settings. Telemedicine is effective for many conditions, but there have been no efficacy trials to date for AUD. Although limited telemedicine infrastructure has been a barrier in the past, the COVID-19 pandemic has proven that it can be rapidly implemented and widely used. There is an urgent need to determine if telemedicine delivered AUD treatment is efficacious to inform dissemination. Therefore, the objective of this study is to evaluate a telemedicine-delivered MI-CBT treatment intervention for AUD (MI-CBT TeleTx) compared to Enhanced Usual Care (EUC) on AUD treatment utilization and alcohol use. Primary care patients with AUD in two large healthcare systems in southeast Michigan will be recruited and randomized to either MI-CBT TeleTx or EUC. Specific Aims are: Aim 1: Determine the impact of providing the option of the TeleTx intervention (n=150) compared to EUC (n=150) in primary care patients with AUD on AUD treatment utilization. Aim 2: Determine the efficacy of the TeleTx intervention compared to EUC on percent drinking days and percent heavy drinking days across 3-, 6-, and 12-month follow-ups. Aim 3: Determine the effect of the TeleTx intervention on alcohol-related consequences and functioning (e.g., quality of life, mental health) and the moderating effect of alcohol risk level reductions. In addition, an exploratory aim is to determine key mediators of the effect of intervention on treatment use (through improved treatment accessibility and reduced stigma) and on alcohol use (through treatment use). Impact: The findings from this study will have a significant public health impact as a novel and scalable approach to address the large AUD treatment gap. Further, the work will be the first large efficacy trial of a telemedicine AUD intervention and test a new model of care designed to engage non-treatment seeking patients and deliver effective AUD treatment to patients outside of traditional specialty care settings.