Recovery Management Checkup for Primary Care (RMC-PC) vs. Screening Brief Intervention and Referral to Treatment (SBIRT) Experiment

描述(由申请人提供)：对成人酒精使用风险的筛查和短暂干预(SBI)始终确定需要短暂干预的患者中有5%-10%，需要更正式酒精治疗的患者中有2%-5%。履行机构的方案经常扩大到包括转诊到治疗(又名SBIRT)，以满足后一类患者的需求，在初级保健中，通过转诊获得治疗的机会增加了15%-20%，剩下80%-85%仍然需要治疗。显然，需要建立有效的模型，将成人SUD与AOD治疗联系起来。康复管理检查(RMC)是将患有肥皂泡的患者与AOD治疗联系起来的有效策略。在3个试验中，与对照组相比，RMC参与者更有可能进入治疗，进入治疗的时间更早，停留时间更长，导致使用药物的天数减少，SUD症状减少。RMC最近针对初级保健设置(RMC-PC)进行了修改，并在联邦合格卫生中心(FQHC)进行了试点。修改包括初级保健人口提出的身体保健(与AOD治疗相反)、拒绝转换部分、电话与面对面联系，以及在表明健康问题时转回初级保健。结果表明，RMC-PC转化了75%最初拒绝在FQHC接受AOD治疗的患者，并使这些患者的治疗链接率翻了两番。在拟议的试验中，我们将：a)在4个FQHC招募300名需要AOD治疗的成年人，b)随机将一半分配到SBIRT，一半分配到SBIRT+RMC-PC，以及c)进行为期12个月的季度随访。假说包括：1)与SBIRT患者相比，SBIRT+RMC-PC患者更有可能：a)更早地开始AOD治疗，b)接受任何AOD治疗，c)接受AOD治疗的天数更多；2)相对于SBIRT患者，SBIRT+RMC-PC患者和接受更多AOD治疗的患者报告的以下天数将更少：a)酗酒，b)酗酒，c)使用大麻，d)其他药物使用，e)SUD问题；3)治疗天数将调节SBIRT+RMC-PC与这些AOD相关行为变化的关系；4)与SBIRT患者相比，SBIRT+RMC-PC患者和使用AOD天数较少的患者在考虑AOD治疗增加的因素后，总医疗利用成本将显著降低；5)AOD使用天数将中介SBIRT+RMC-PC与总医疗利用成本的关系。

DESCRIPTION (provided by applicant): Screening and Brief Intervention (SBI) for risky adult alcohol use consistently identifies 5-10% of patients in need of brief intervention and 2-5% in need of more formal alcohol treatment. SBI programs are often expanded to include Referral to Treatment (aka SBIRT) to address the latter patients' needs and in primary care have increased access to treatment by 15-20% via referrals leaving 80-85% still needing treatment. Effective models of linking adults with SUD to AOD treatment are clearly needed. Recovery Management Checkups (RMC) are an effective strategy for linking individuals with SUDs to AOD treatment. In 3 trials, compared to the control group, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, contributing to fewer days of substance use and fewer SUD symptoms. RMC was recently modified for primary care settings (RMC-PC) and piloted in Federally Qualified Health Centers (FQHC). Modifications include a primary care population presenting for physical health care (as opposed to AOD treatment), a refusal conversion component, telephone vs. face-to-face linkage, and referrals back to primary care when health problems are indicated. Results indicated that RMC-PC converted 75% of those who initially refused a referral for AOD treatment at the FQHC and quadrupled the linkage rate to treatment for these individuals. In the proposed trial, we will: a) recruit 300 adults needing AOD treatment at 4 FQHCs, b) randomly assign half to SBIRT and half to SBIRT+RMC-PC, and c) conduct quarterly follow-ups for 12-months. Hypotheses include: 1) Relative to the SBIRT patients, SBIRT+ RMC-PC patients will be more likely to: a) initiate AOD treatment sooner, b) receive any AOD treatment, and c) receive more days of AOD treatment; 2) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those who get more AOD treatment will report less days of: a) alcohol use, b) heavy alcohol use, c) cannabis use, d) other drug use, and e) SUD problems; 3) days of treatment will mediate the relationship between SBIRT+RMC-PC and changes in the these AOD related behaviors; 4) Relative to the SBIRT patients, SBIRT+RMC-PC patients and those with fewer days of AOD use will have significantly less total health care utilization costs after factoring in increases in AOD treatment; 5) Days of AOD use will mediate the relationship between SBIRT+RMC-PC and total cost of health care utilization.