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

 描述（由申请人提供）：过度饮酒（艾德）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是认识不足和治疗不足。尽管许多患有艾德/AUD的人每年都去看初级保健医生，但在初级保健中治疗艾德/AUD的模型的研究和实施有限。医疗保健系统的重要变化和酒精研究的进展为将艾德/AUD治疗纳入初级保健实践提供了新的和潜在的变革机会。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病护理模式，以治疗初级保健中的酒精问题，类似于目前用于治疗包括抑郁症在内的其他慢性病的模式。然而，开发和测试这种模型的研究却令人惊讶地有限。本提案的主要目的是开发和测试慢性护理模式，以治疗艾德/AUD在以患者为中心的模式家庭（PCMH）使用NIH阶段模型的干预发展。具体而言，使用混合方法的方法，本研究提出了适应和测试的协作护理（CC）模式抑郁症治疗艾德/AUD在高容量PCMH。重要的是，我们将在PCMH已经实施的筛查、短暂干预和转诊治疗（SBIRT）计划上建立CC模型。值得注意的是，这种SBIRT模式目前将那些患有艾德/AUD的人推荐给专业治疗提供者。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。在此阶段，将针对艾德/AUD调整相关抑郁CC方案和措施，并对PCMH招募的参与者（n = 25）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和饮酒结果数据的检查的模型改进。在此阶段，将对参与者（n = 60）进行评估并随访三个月。迭代开发将侧重于：1）利用阶梯式治疗模式，包括门诊戒毒、行为干预和药物干预和管理，2）最大限度地提高患者参与度，3）平衡PCMH中治疗艾德/AUD的资源和专业知识限制。在第三阶段，我们将进行一个小型的随机对照试验的细化模型。将招募受试者（n = 90）并随机分配至CC-AUD或仅SBIRT组。参与者将在1个月和3个月时接受随访，并将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.