Project START: Screening to Augment Referral to Treatment

描述（由申请人提供）：药物滥用与个人和社会的高成本有关，但只有不到三分之一的药物依赖者和6%的滥用药物者接受过治疗。对药物滥用进行筛查、短暂干预和转诊治疗（SBIRT），并在初级保健环境中部署，具有治疗潜力，但临床医生通常与患者在一起不到10分钟，必须解决一系列医疗问题。由计算机或护士提供的SBIRT将是初级保健临床医生对药物滥用者的治疗手段的有力补充，但这些干预措施需要与常规护理进行测试。妇女接受药物滥用治疗的比率较低，她们通常在生殖健康机构接受初级医疗保健。美国妇产科医师学会建议进行普遍筛查，以确定妇女是否滥用药物，但除了酒精和烟草，没有经验数据支持这种方法的有效性。事实上，美国预防服务工作组在2008年的一份报告中指出，在初级保健环境中缺乏关于SBIRT的惊人数据。我们建议进行一项对照的、实用的、随机的临床试验，将两种由计算机或训练有素的护士提供的sbirt与常规护理（对照条件）进行比较。我们将招募660名使用各种精神活性物质（如烟草、大麻、可卡因、甲基苯丙胺、酒精、阿片类药物、处方药）的妇女，并将她们随机分配到基于激励原则的护士管理转诊、基于激励原则的计算机转诊或简短建议。所有受试者都将收到一本小册子，里面有资料和资源。随机效应和逻辑回归模型将用于估计3组在1、3和6个月时主要药物使用、治疗开始和治疗出勤率的组间差异。随机效应模型也将用于测试计算机和护士管理转诊的增量成本。

DESCRIPTION (provided by applicant): Substance abuse is associated with high costs to individuals and to society but less than one- third of individuals who are drug dependent and 6% of those who abuse drugs ever receives treatment. Screening, a brief intervention and referral for treatment (SBIRT) for substance abuse and deployed in a primary care setting has therapeutic potential but clinicians typically have less than 10 minutes with a patient and must address a range of medical problems. SBIRT, delivered by computer or nurse, would be a strong addition to a primary care clinician's therapeutic armamentarium for substance abusers but these interventions need to be tested against usual care. Women, who have lower rates of substance abuse treatment, typically receive primary medical care in a reproductive health setting. The American College of Obstetricians and Gynecologists recommends universal screening to determine if women abuse substances but, other than for alcohol and tobacco, there are no empirical data to support the effectiveness of this approach. In fact, the astonishing lack of data on SBIRT in primary care setting is noted by the US Preventative Services Task Force, in a 2008 report. We propose a controlled, pragmatic, randomized clinical trial that would compare two SBIRTs, offered either by computer or a trained nurse, to usual care (a control condition). We will recruit 660 women with a range of psychoactive substance use (e.g. tobacco, marijuana, cocaine, methamphetamines, alcohol, opiates, prescription drugs) and randomize them to a nurse- administered referral based upon motivation principles, a computer referral based upon motivation principles or brief advice. All subjects will receive a pamphlet with information and resources. Random effects and logistic regression models will be used to estimate group differences in primary drug used, treatment initiation, and treatment attendance among the 3 groups at 1, 3, and 6 months. Random effects models will also be used to test the incremental costs of the computer and nurse administered referrals. PUBLIC HEALTH RELEVANCE: Screening, brief interventions and referral to treatment for substance abuse have therapeutic potential but are understudied in primary care settings, in women and drug users. We propose a pragmatic trial that would randomize 660 women in a reproductive health setting who have a range of psychoactive substance use (e.g. tobacco, marijuana, cocaine, etc.) problems to a nurse-administered referral based upon motivation principles, or a computer referral based upon motivation principles or brief advice (control condition). Costs of the conditions would be estimated to provide models of cost effectiveness.