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

描述（由申请人提供）：药物使用/滥用的筛查、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。虽然SBIRT的组成部分，特别是筛选和简短的干预措施，已被证明是有效的策略，以解决酒精滥用的初级保健，数据是有限的，使用所有的组成部分SBIRT的吸毒患者，特别是在急诊科（艾德）。此外，由于环境往往混乱的ED，许多后勤和实际的障碍存在通过整个SBIRT模型在这种设置。因此，拟定的研究将使用带音频的触摸屏平板电脑进行计算机化筛查（约4，900例患者），并将在双因子设计（3x 2）中测试干预策略。具体而言，在过去3个月内药物使用筛查呈阳性的900名内城艾德18-60岁患者将被随机分配至三种基于ED的条件的组合（计算机短暂干预-CBI;干预者短暂干预-IBI;加强常规护理-EUC）和两种随访条件（适应性动机增强疗法;增强的常规护理-EUC），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“转诊治疗”或“SBIRT的“RT”分量。对于所有基于艾德的疾病和随访疾病，将在基线时进行分层随机分配[按性别和药物使用障碍的诊断（是/否）]。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，以及艾滋病毒预防材料。认识到简短干预对于所有使用药物的患者的改变是重要的，但不一定足够，拟议研究的主要具体目的将确定基于即时“现场”ED的简短干预条件、2个月随访简短治疗条件和条件组合的独立有效性，在6个月和12个月时减少药物使用并改善健康相关结果（包括身心健康和HIV风险行为）。使用最先进的计算机技术进行筛查和简单干预，有可能比亲自筛查和简单干预接触更多的艾德患者。开发有效优化SBIRT组分的方法对改善使用药物的患者的结果具有广泛而强大的公共卫生意义。公共卫生相关性：急诊室（艾德）设置是一个独特的接入点的个人（特别是穷人和服务不足），否则谁不会被识别或提供任何援助，他们的药物使用。开发有效和高效地改善使用药物的患者的结果的方法可能具有广泛和强大的公共卫生影响。使用最先进的计算机技术进行筛查和简单干预，有可能比亲自筛查和简单干预接触更多的艾德患者。

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. PUBLIC HEALTH RELEVANCE: The Emergency Department (ED) setting is a unique point of access for individuals (especially the poor and underserved) who otherwise would not be identified or provided with any assistance regarding their drug use. Developing methods to efficiently and effectively improve outcomes for patients who use drugs can have wide-ranging and powerful public health implications. 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.