Optimizing SBIRT for Drug-Using Patients in an Inner-City Emergency Department

描述（由申请人提供）：药物使用/滥用的筛选、简短干预和转诊治疗（SBIRT）为医疗环境中的患者提供了早期发现、简短干预/治疗和药物使用治疗转诊的机会。尽管SBIRT的组成部分，特别是筛查和简短干预，已被证明是解决初级保健中酒精滥用的有效策略，但关于在吸毒患者中使用SBIRT的所有组成部分的数据有限，特别是在急诊科（ED）。此外，由于急诊室的环境往往很混乱，在这种情况下采用整个SBIRT模式存在许多后勤和实际障碍。因此，拟议的研究将使用带有音频的触摸屏电脑平板电脑进行计算机筛查（约4,900名患者），并将在双因子设计（3x2）中测试干预策略。具体来说，900名年龄在18-60岁、在过去3个月内药物使用筛查呈阳性的市中心ED患者将被随机分配到三种基于ED的条件（计算机简短干预- cbi；干预者简短干预- ibi；强化常规护理- euc）和两种随访条件（适应性动机增强治疗- amet；强化常规护理- euc），这些条件将在ED后2个月进行。所有符合药物使用障碍标准的个体将额外接受SBIRT的“转诊治疗”或“RT”部分。分层随机分配[按性别和药物使用障碍的诊断（是/否）]将在基线对所有ED和随访条件进行。所有参与者将收到书面信息，包括药物滥用和其他社区资源，以及艾滋病预防材料。认识到短期干预对于改变所有使用药物的患者是重要的，但不一定是充分的，拟议研究的主要具体目标将确定立即“现场”基于ed的短暂干预条件、2个月随访的短暂治疗条件和条件组合在减少药物使用和改善健康相关结果（包括身体和心理健康）方面的独立有效性。以及艾滋病毒风险行为)。使用最先进的计算机技术进行筛查和简短干预比面对面筛查和简短干预有可能达到更多的ED患者。开发有效优化SBIRT成分的方法对改善用药患者的预后具有广泛而强大的公共卫生影响。

DESCRIPTION (provided by applicant): Screening, brief interventions, and referral to treatment (SBIRT) for drug use/abuse offers opportunities for early detection, brief intervention/treatment, and substance use treatment referrals for patients in medical settings. Although SBIRT components, particularly screening and brief interventions, have been shown to be effective strategies for addressing alcohol misuse in primary care, data are limited on using all of the components of SBIRT for drug-using patients, particularly in the Emergency Department (ED). Further, because of the often chaotic environment of EDs, many logistical and practical impediments exist for the adoption of the entire SBIRT model in this setting. Therefore, the proposed study will use computerized screening using touch screen computer tablets with audio (~4,900 patients) and will test intervention strategies in a two-factorial design (3x2). Specifically, 900 patients aged 18-60 in an inner-city ED who screen positive for drug use in the past 3 months will be randomized to the combinations of three ED-based conditions (computer brief intervention-CBI; intervener brief intervention-IBI ; enhanced usual care-EUC), and two follow-up conditions (adapted motivational enhancement therapy-AMET; enhanced usual care-EUC) that will take place 2 months post-ED. All individuals who meet criteria for a drug use disorder will additionally receive the "referral to treatment" or "RT" component of SBIRT. Stratified random assignment [by gender and diagnosis of a drug use disorder (yes/no)] will take place at baseline for all ED- based and follow-up conditions. All participants will receive written information including substance abuse and other community resources, and HIV prevention materials. Recognizing that brief interventions are important, but not necessarily sufficient, for change in all patients who use drugs, the primary specific aims of the proposed study will determine the independent effectiveness of immediate "on-the-spot" ED-based brief intervention conditions, 2-month follow- up brief treatment conditions, and combinations of conditions, for decreasing drug use and improving health-related outcomes (including physical and mental health, and HIV risk behavior) at 6 and 12 months. The use of state-of-the-art computer technology for screening and brief interventions has the potential to reach greater numbers of ED patients than is possible with in- person screening and brief intervention. Developing methods to efficiently and effectively optimize SBIRT components has wide-ranging and powerful public health implications for improving outcomes for patients who use drugs.