PATIENTS, CLINICS, AND SYSTEMS: SCREENING FOR ALCOHOL

大多数有酒精问题的患者都去了普通医疗和其他临床环境，而不是直接接受酒精治疗。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。当患者出现在产前护理、急救服务或医疗预约时，酒精问题的识别和治疗一直是一个长期的临床研究兴趣。临床研究的职业中期研究人员奖将允许申请者在关键的专业时期专注于以患者为中心的研究兴趣。目前的项目名为“骨髓移植中的酒精滥用”，目的是验证这样一种假设，即滥用酒精或依赖会对骨髓移植后的存活率产生不利影响。骨髓移植是美国第二常见的主要器官移植，也是供体器官供应最少的移植。一项针对124名接受异基因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。这项名为“医疗补助管理的医疗保健中的酒精筛查”的拟议项目的目的是测试这样一种假设，即在医疗计划(HMO)注册时对医疗补助成员进行常规酒精和药物滥用筛查不如在HMO初级保健网站进行酒精和药物滥用筛查有效。在登记时对2000名医疗补助参与者进行筛查的样本将与715名患者的样本进行比较，这些患者将在初级保健HMO网站开始护理时接受酒精和药物滥用筛查。将比较他们在筛查后12个月内接受酒精和药物滥用治疗、精神科和内科治疗的情况。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影响，因为移植医学和管理式护理日益普遍，并强调了对患者进行酒精和药物筛查的必要性。

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.