Preventing Drug Use in Low Income Clinic Populations

描述（由申请人提供）：退出使用药物干预试验（QUIT）将是美国第一项随机对照试验，该试验旨在检测洛杉矶县2个安全网诊所的初级保健临床医生提供的简短干预方案对减少低收入成年患者（18岁及以上）中“风险”药物使用和药物相关伤害的影响。对于这项小型试验，我们将对使用兴奋剂（可卡因或安非他明）的“风险”患者进行抽样，兴奋剂是我们诊所患者中最常用的严重药物。在这项研究中，“有风险”的兴奋剂使用被定义为目前（过去90天）使用兴奋剂，衡量标准是世卫组织酒精物质参与筛查试验（ASSIST）的自我报告总分为4至26分。将对总计8，000例患者进行筛选，以产生12个月有效样本量，即每种疾病（1）干预疾病或（2）涉及常规护理的对照疾病200例合格患者。在干预条件下，关于停止使用兴奋剂的非常简短（不到5分钟）的临床医生建议之后，将进行两次为期2周和6周的访视后药物健康教育课程，内容是停止使用兴奋剂，并警告不要使用其他“有风险”的物质，如酒精和烟草。分配到对照组的患者将在基线访视时接受临床医生的药物使用标准护理，随后将进行两次访视后电话健康教育会议，其持续时间与干预会议相同，但将解决健康饮食，体力活动和安全带使用问题。将在随机化后6个月和12个月进行随访评估。戒烟项目的框架是社会行动理论，简短的干预协议是基于NIDA的预防研究原则和5A方法的效用，以帮助患者在临床环境中改变行为（询问，建议，评估，协助，安排）。如果发现在社区卫生中心环境中有效，这种临床医生和电话兴奋剂使用健康教育计划可能成为健康促进活动的模式。这将扩大到所有“有风险”的药物使用，并在社区保健中心之间共享。公共卫生相关性：拟议的研究将解决减少非法药物使用，特别是兴奋剂使用的迫切需要，以及城市初级保健安全网诊所低收入种族多样化患者人群中与药物有关的伤害的发生。一旦开始吸毒，低收入的种族多样化人口就有可能加速走向药物依赖，这对公共卫生政策制定者和预防吸毒工作构成特别关切。这项研究将是第一个标准化的药物筛选和医生简短的干预种族多样化的“风险”兴奋剂使用者，这是偶然或频繁使用没有依赖的生理或心理表现，它可能会有效地中断他们的依赖途径。

DESCRIPTION (provided by applicant): The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing `at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at 2 safety net clinics in Los Angeles County. For this small trial, we will sample patients with `at risk' use of stimulants (cocaine or amphetamines), the most commonly used serious drugs among patients at our clinic sites. "At risk" stimulant use is defined in this study as current use (past 90 days) of stimulants measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 8,000 patients will be approached for screening to yield a 12-month effective sample size of 200 eligible patients per condition (1) an intervention condition or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting stimulants use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting stimulant use and cautioning against use of other `at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician, which will be followed by two post-visit telephone health education sessions that will be of equal duration as the intervention sessions but will address healthy eating, physical activity, and seat belt use. Follow- up assessments will be conducted at 6 and 12 months post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone stimulant-use health education program could become a model for health promotion activities. that would be expanded to all `at risk' substance use and shared between community health centers. PUBLIC HEALTH RELEVANCE: The proposed study will address the critical need to reduce illegal drug use, in particular stimulant use, and the occurrence of drug-related harm in low-income racially diverse patient populations at urban primary care safety-net clinics. At risk for accelerated trajectories to drug dependence once drug use begins, low-income racially diverse populations pose particular concern for public health policy makers and drug-use prevention efforts. The study will be the first of its kind to standardize drug screening and physician brief intervention among racially diverse "at risk" stimulant users, that is casual or frequent use without the physiological or psychological manifestations of dependence, and it may effectively interrupt their pathway to dependence.