Brief Intervention in the ER in Poland

描述（由申请人提供）：此国际合作项目发展奖助金提案的目的是：1)在波兰索斯诺维茨（Sosnowiec）的急诊室（ER），使用护士提供的动机干预来检查筛查、短暂干预和转诊治疗（SBIRT）在减少重度饮酒（每周饮酒天数、每天饮酒数量、每次饮酒的最大数量）和酒精相关问题（RAPS4和SIPS + 6）方面的有效性，相对于有评估和没有评估的标准护理；并且，2)确定与干预有效性相关的变量，并预测成功的治疗结果。我们计划将在初级保健中取得成功的动机干预措施（最近在美国14个学术性急诊医学SBIRT研究中实施）转化为美国以外的非学术性急诊环境。该SBIRT研究最近由NIAAA和SAMHSA资助，是第一个多地点合作研究，对急诊室中高危和依赖饮酒进行筛查、短暂干预和转诊。我们将进行一项盲法随机简短动机干预试验，对18岁以上的受伤和非受伤患者进行风险或依赖（使用RAPS4）饮酒筛查。那些筛查呈阳性的人将被要求参加这项研究。同意的患者将随机分为三组：筛选组、评估组和简短干预组，每组n=292。干预组和评估组将在3个月时进行随访，所有三组在12个月时进行随访。

DESCRIPTION (provided by applicant): The aims of this Developmental Grant Proposal for Collaborative International Projects are to: 1) examine the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) using a nurse-delivered motivational intervention, relative to standard care with and without assessment, on a reduction in heavy drinking (drinking days per week, number of drinks per day, maximum number of drinks on an occasion) and alcohol-related problems (RAPS4 and SIPS + 6) in the emergency room (ER) in Sosnowiec, Poland; and, 2) identify variables that are related to effectiveness of the intervention and that predict successful treatment outcome. We plan to translate motivational interventions that have been successful in primary care and which were recently implemented in the U.S. 14 Academic Emergency Medicine SBIRT study to a non-academic ER setting outside of the U.S. The SBIRT study, recently funded by NIAAA and SAMHSA, is the first multisite, collaborative study of screening, brief intervention and referral for at-risk and dependent drinking in the ER. We will conduct a blinded randomized brief motivational intervention trial in which both injured and noninjured patients over the aged of 18 will be screened for at-risk or dependent (using the RAPS4) drinking. Those screening positive will be asked to participate in the study. Consenting patients will be randomized into one of three groups: screened only, assessed, and brief intervention, with n=292 in each group. Intervention and assessment groups will be followed-up at 3 months and all three groups at 12 months. Modifying variables include drinking in the event, risk taking disposition and readiness and stage of change. Prior research in the ER in Sosnowiec and a pilot feasibility study of SBIRT in Sosnowiec suggest: 1) a large number of "at risk", heavy problem and dependent drinkers who meet screening criteria for brief intervention in a relatively short period of time; 2) a socialized health care system which provides equal access to care and is not subject to selection bias affecting patient access; 3) a patient sample covering a large geographic area; 4) a stable environment facilitating high follow-up rates post-intervention; and, 5) a well integrated referral system and high accessibility to alcohol treatment services. Outcome data will be analyzed using ANOVA, logistic regression and Generalized Estimating Equations. The interaction of modifying variables on outcomes will also be analyzed. The ER is an important setting for screening and brief intervention for those with alcohol-related problems in order to reduce subsequent alcohol-related ER visits and associated costs and increase quality of life. This project will inform the development and spread of more effective techniques and protocols for addressing at-risk and dependent drinking in the ER, and provide a better understanding of those factors that influence effectiveness of brief intervention and predict successful patient outcomes.