Leveraging technology to address unhealthy drug use in primary care settings

 描述（由申请人提供）：未能识别和治疗在主流初级保健环境中看到的患者中的不健康药物使用，这代表着错过了改善人口健康的机会。筛查、短暂干预和转诊治疗（SBIRT）计划已被推广以解决这一问题，但最近的随机临床试验表明缺乏疗效。现在是时候“回到绘图板”，以检查新的护理模式，可以有效地解决不健康的药物使用在初级保健设置。SBIRT研究只测试了一种“专家”模式，这种模式将筛查和干预的责任转移到不属于常规初级保健团队的专业健康教育工作者身上。另一种模式是将筛查和干预纳入常规初级保健，采用对其他常见慢性健康状况有效的相同方法，可能对减少不健康药物使用更有效。卫生信息技术的创新应用可以克服实施初级保健综合方法的障碍。基于平板电脑的物质使用筛查和干预工具（SUSIT）旨在增加初级保健提供者提供的物质使用简短干预措施。SUSIT由技术接受模型提供信息，并具有三个要素：1）时间和工作流程限制得到解决，患者在临床就诊前完成自我管理的筛查，并在护理点向初级保健提供者提供结果; 2）通过临床决策支持（CDS）增强提供者的知识，这已被证明在改变提供者行为以有效地解决其他健康状况方面是有效的;以及3）在每次初级保健访问时通过临床提醒来改善提供者激活。该系统的筛选部分已经开发。这里的目标是建立临床决策支持，然后测试10个初级保健提供者的完整SUSIT模型。混合方法将评估其在提供者和患者中的可接受性和采用情况，并收集关于其减少中度风险药物使用（定义为低于物质使用障碍阈值的不健康使用）的功效的初步数据。前后设计将确定仅筛选（SO）与SUSIT干预阶段（每个阶段n=75）入组的患者接受的物质使用干预剂量和药物使用变化。有3个具体目标：目标1是开发临床决策支持，协助初级保健提供者， 进行简短的干预。目标2是评估SUSIT对患者接受的物质使用短暂干预剂量的影响，目标3是收集SUSIT方法减少中度风险药物使用的有效性的初步证据。SUSIT方法的创新是利用卫生信息技术支持高效和有效地提供物质使用筛查和干预措施。这项研究的意义在于，它开发和测试了一种替代的，实践综合模型，用于解决初级保健中的不健康药物使用问题。

 DESCRIPTION (provided by applicant): The failure to identify and treat unhealthy drug use among patients seen in mainstream primary care settings represents a missed opportunity to improve population health. Screening, brief intervention, and referral to treatment (SBIRT) programs have been promoted to address this, but recent randomized clinical trials have demonstrated lack of efficacy. It is time to go 'back to the drawing board' to examine new models of care that could effectively address unhealthy drug use in primary care settings. SBIRT studies have only tested a 'specialist' model, which shifts the responsibility for screening and interventions onto a specialized health educator who is not part of the regular primary care team. An alternative model, which integrates screening and interventions into regular primary care, using the same approaches that are effective for other common chronic health conditions, may be more effective for reducing unhealthy drug use. Innovative application of health information technology can overcome barriers to implementing a primary care-integrated approach. The tablet computer-based Substance Use Screening and Intervention Tool (SUSIT) is designed to increase delivery of substance use brief interventions by primary care providers. The SUSIT is informed by the Technology Acceptance Model, and has three elements: 1) time and workflow constraints are addressed with patient self-administered screening completed before the clinical encounter, with results presented to the primary care provider at the point of care; 2) provider knowledge is enhanced with clinical decision support (CDS),which has proven effective at changing provider behavior to effectively address other health conditions; and 3) provider activation is improved with clinical reminders at every primary care visit. The screening component of the SUSIT has already been developed. The objective here is to build the clinical decision support, and then test the full SUSIT model with 10 primary care providers. A mixed methods approach will assess its acceptability and adoption among providers and patients, and gather preliminary data on its efficacy for reducing moderate-risk drug use (defined as unhealthy use that is below the threshold of a substance use disorder). A pre-post design will ascertain the dose of substance use intervention received and changes in drug use among patients enrolled in the screening only (SO) versus SUSIT intervention period (n=75 in each period). There are 3 specific aims: Aim 1 is to develop clinical decision support that assists primary care providers in carrying out a brief intervention. Aim 2 is to assess the impact of the SUSIT on dose of substance use brief intervention received by patients, and Aim 3 is to gather preliminary evidence on the efficacy of the SUSIT approach for reducing moderate-risk drug use. The innovation of the SUSIT approach is to leverage health information technology to support efficient and effective delivery of substance use screening and interventions. The significance of this research is that it develops and tests an alternative, practice-integrated model for addressing unhealthy drug use in primary care.