Collaborative care for alcohol use disorders in the patient-centered medical home

 描述(申请人提供)：过度饮酒(ED)和酒精使用障碍(AUD)仍然是美国主要的公共卫生问题之一，但这个问题在很大程度上没有得到充分的认识和治疗。尽管许多患有ED/AUD的人每年都去看初级保健医生，但在初级保健中治疗ED/AUD的模式的研究和实施有限。医疗保健系统的重要变化和酒精研究的进步为将ED/AUD治疗纳入初级保健实践提供了新的和潜在的变革性机会。特别是，这些变化导致了新的以患者为中心的综合护理模式的发展，促进了初级保健中的治疗行为健康问题。专家们一再呼吁开发一种慢性护理模式，以在初级保健中治疗酒精问题，类似于现在用于治疗包括抑郁症在内的其他慢性病的模式。然而，开发和测试这类模型的研究出人意料地有限。这项建议的主要目的是开发和测试一种慢性护理模式，在以患者为中心的模式之家(PCMH)使用干预发展的NIH阶段模式来治疗ED/AUD。具体地说，使用混合方法，本研究建议调整和测试抑郁症的协作护理(CC)模式，以在大容量PCMH中治疗ED/AUD。重要的是，我们将在PCMH已有的筛查、短暂干预和转诊治疗(SBIRT)计划的基础上建立CC模型。值得注意的是，这种SBIRT模式目前将患有ED/AUD的患者转介给专门的治疗提供者。建议的研究将分三个阶段进行。第一阶段将涉及抑郁症CC模型的初步适应。在这一阶段，相关的抑郁症CC方案和措施将适用于ED/AUD，并在PCMH招募的参与者(n=25)上进行试点测试。第二阶段将涉及基于患者和PCMH工作人员反馈的迭代周期以及对饮酒结果数据的检查的模型改进。在这一阶段，将对参与者(n=60)进行评估并跟踪三个月。迭代开发将集中于：1)利用包括门诊戒毒、行为干预和药物干预和管理的分级护理模式，2)最大限度地提高患者的参与度，3)平衡在PCMH治疗ED/AUD的资源和专业知识限制。在第三阶段，我们将对改进后的模型进行小型随机对照试验。参与者(n=90)将被招募并随机分为CC-AUD组或SBIRT组。参与者将在1个月和3个月时接受跟踪，并检查有关饮酒结果的主要结果数据。

 DESCRIPTION (provided by applicant): Excessive drinking (ED) and alcohol use disorders (AUD) remain one of the nation's leading public health problems, yet this problem is largely under-recognized and undertreated. Although many people with ED/AUD see a primary care physician annually, there has been limited research and implementation of models to treat ED/AUD in primary care. Important changes in the healthcare system and advances in alcohol research offer new and potentially transformative opportunities to integrate ED/AUD treatment into primary care practices. In particular, these changes have led to the development of new patient-centered, integrated care models that facilitate the treatment behavioral health issues in primary care. Experts have repeatedly called for the development of a chronic care model to treat alcohol problems in primary care, similar to models now used to treat other chronic illnesses, including depression. Yet, research to develop and test such models has been surprisingly limited. The primary aim of this proposal is to develop and test a chronic care model to treat ED/AUD in the patient-centered model home (PCMH) using the NIH stage model of intervention development. Specifically, using a mixed methods approach, this study proposes to adapt and test the collaborative care (CC) model for depression to treat ED/AUD in a high volume PCMH. Importantly, we will build the CC model onto a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program that is already in place in the PCMH. Notably, this SBIRT model currently refers those with ED/AUD out to specialty treatment providers. The proposed study will be conducted in three phases. Phase I will involve initial adaptation of the CC model for depression. During this phase, relevant depression CC protocols and measures will be adapted for ED/AUD and piloted tested on participants (n = 25) recruited in a PCMH. Phase II will involve model refinement based on iterative cycles of patient and PCMH staff feedback and examination of drinking outcome data. During this phase, participants (n = 60) will be assessed and followed for three months. Iterative development will focus on: 1) utilizing a stepped-care model of treatment which will include outpatient detoxification, behavioral interventions, and medication intervention and management, 2) maximizing patient engagement, and 3) balancing the resource and expertise constraints of treating ED/AUD in a PCMH. During Phase III, we will conduct a small randomized controlled trial of the refined model. Participants (n = 90) will be recruited and randomized to CC-AUD or SBIRT-Only. Participants will be followed at 1 and 3 months and primary outcome data on drinking outcomes will be examined.