Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence

项目总结/摘要 背景：不健康的饮酒是美国可预防死亡的第三大原因 并且与许多社会和健康问题相关。它是最近的一个关键因素， 美国人的预期寿命下降，特别是中年白色美国人和生活在 农村地区尽管疾病的负担和建议，以筛选不健康的 酒精使用，相对较少的人谁访问初级保健提供者在美国被问及 饮酒或与健康专家讨论饮酒问题。实践往往缺乏正式的 筛选和随后提供适当干预措施的过程。 目的：目的是（1）确定初级保健实践促进（PF）是否可以 实现快速传播和实施循证筛查、咨询， 药物辅助治疗（MAT）用于不健康的酒精使用和（2）用于较慢的实践 采用，比较提供嵌入式远程医疗服务是否加速了 传播和实施筛查、咨询和MAT。 方法：STUN酒精使用现在是一个适应性随机对照试验，以评估 初级保健PF和提供嵌入式远程医疗服务对循证医学的影响 在135个初级保健实践中进行筛查、咨询和MAT，提供者不超过10人。每个 已登记的实践将接受PF干预。接受PF 6个月后 干预后，处于较低50百分位数（基于性能）的实践将被随机分配至 继续PF或嵌入式远程保健服务加PF在未来12个月。的PF 干预包括现场QI促进、EHR支持、培训和学术细节。 潜在影响：成功的干预措施将显著降低疾病负担 不健康的酒精使用。这项研究将提供关于 实践促进对不健康酒精摄入循证SBI和MAT的影响 在大规模向中小规模初级保健实践提供时使用。它还将 生成关于嵌入式远程医疗服务是否可以改善 对吸收较慢的做法进行循证筛查和干预。的结果 严格进行的评估预计将产生积极的影响，为AHRQ提供 有效和高效地加速传播所需的证据， 将与不健康饮酒有关的证据纳入初级保健实践。

Project Summary/Abstract Background: Unhealthy alcohol use is the third leading cause of preventable deaths in the US and is associated with many societal and health problems. It is a key contributor to recent declines in US life expectancy, especially among middle-aged white Americans and those living in rural areas. Despite the burden of illness and recommendations to screen for unhealthy alcohol use, relatively few people who visit primary care providers in the US are asked about alcohol use or ever discuss alcohol use with a health professional. Practices often lack a formal process for screening and subsequent delivery of appropriate interventions. Objectives: The objectives are (1) to determine if primary care practice facilitation (PF) can achieve rapid dissemination and implementation of evidence-based screening, counseling, and medication assisted therapy (MAT) for unhealthy alcohol use and (2) for practices with slower uptake, to compare whether providing embedded telehealth services accelerates the dissemination and implementation of screening, counseling, and MAT. Methods: STUN Alcohol Use Now is an adaptive randomized, controlled trial to evaluate the effect of primary care PF and providing embedded telehealth services on evidence-based screening, counseling, and MAT in 135 primary care practices with 10 or fewer providers. Each enrolled practice will receive the PF intervention. After 6 months of receiving the PF intervention, practices in the lower 50th percentile (based on performance) will be randomized to continued PF or to embedded telehealth services plus PF for the next 12 months. The PF intervention includes onsite QI facilitation, EHR support, training, and academic detailing. Potential Impact: A successful intervention would significantly reduce the burden of disease from unhealthy alcohol use. The study will produce fundamentally important evidence about the effect of practice facilitation on uptake of evidence-based SBI and MAT for unhealthy alcohol use when delivered on a large scale to small to medium-size primary care practices. It will also generate scientific knowledge about whether embedded telehealth services can improve use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by supplying AHRQ with the evidence it needs to effectively and efficiently accelerate the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.