PATIENTS, CLINICS, AND SYSTEMS: SCREENING FOR ALCOHOL

大多数有酒精问题的患者出现在一般医疗和其他临床环境中，而不是直接进行酒精治疗。未经治疗的酒精问题的后果是众所周知的，包括一系列的医疗和社会并发症。识别和治疗酒精问题，当病人出现产前护理，急救服务，或医疗预约，一直是一个长期的临床研究兴趣。临床研究职业中期研究者奖将允许申请人在关键的专业时期专注于以患者为导向的研究兴趣。当前项目“骨髓移植中的酒精滥用”的目的是检验酒精滥用或依赖对骨髓移植后生存有不利影响的假设，骨髓移植是美国第二大最常见的主要器官移植，也是供体器官供应限制最少的移植。一项124例接受同种异体骨髓移植的慢性髓系白血病患者的前瞻性队列研究正在进行中。拟议项目“医疗补助管理医疗中的酒精筛查”的目的是检验这样一种假设，即在健康计划（HMO）登记时对医疗补助成员进行常规酒精和药物滥用筛查的效果不如在HMO初级保健站点进行酒精和药物滥用筛查。在登记时筛选的2000名医疗补助计划参保者的样本将与715名患者的样本进行比较，这些患者将在初级保健HMO站点开始治疗时进行酒精和药物滥用筛查。将比较筛查后12个月内他们对酒精和药物滥用治疗、精神病治疗和医学治疗的利用情况。将对150名初级保健筛查呈阳性的患者进行更深入的研究。这两项研究都将侧重于患者，但将具有重要的实践和政策意义，因为移植医学和管理式护理越来越普遍，并强调需要对患者进行酒精和药物筛查。

The majority of patients with alcohol problems present to general medical and other clinical settings, rather than directly to alcohol treatment. The consequences of untreated alcohol problems are well known, and include a whole range of medical and social complications. The identification and treatment of alcohol problems, when patients present for prenatal care, emergency services, or a medical appointment, has been a longstanding clinical research interest. A Midcareer Investigator Award in Clinical Research would allow the applicant to focus on patient-oriented research interests during a critical professional period. The purpose of the current project, "Alcohol Abuse in Bone Marrow Transplant," is to test the hypothesis that alcohol abuse or dependence has an adverse impact on survival after bone marrow transplant, the second most frequent major organ transplant in the United States and the transplant with the least limited donor organ supply. A prospective cohort study of 124 patients with Chronic Myeloid Leukemia undergoing allogeneic bone marrow transplant is underway. The purpose of the proposed project, "Alcohol Screening in Medicaid Managed Care," is to test the hypothesis that routine alcohol and substance abuse screening of Medicaid members at health plan (HMO) enrollment is less effective than alcohol and substance abuse screening at the HMO primary care site. A sample of 2,000 Medicaid enrollees screened at enrollment will compared with a sample of 715 patients who will be screened for alcohol and substance abuse as they initiate care at primary care HMO sites. Their utilization of alcohol and substance abuse treatment, psychiatric and medical treatment for 12 months subsequent to screening will be compared. A sample of 150 patients with positive primary care screens will be studied more intensively. Both of these studies will focus on patients, but will have important practice and policy implications, as transplant medicine and managed care are increasingly prevalent and underscore the need for alcohol and drug screening of patients.