mHealth to Enhance & Sustain Drug Use Reduction of the QUIT BI in Primary Care

项目总结。Quit-Mobile研究建议使用手机自我监控和反馈 为了加强和持续超过12个月的戒毒干预试验(QUIT)的影响，一项... 情感筛查和短暂干预(SBI)以前成功地减少了危险药物的使用(即，适度 用途)对低收入、多样化的患者进行为期3个月的随访。我们建议进行戒烟-移动研究 针对在南卡罗来纳州联邦合格医疗中心(FQHC)的8家诊所接受护理的初级保健患者 加州超过12个月的随访，与戒烟和常规护理(UC)进行比较。拟议的研究是一项有效的- 高效实施混合类型1设计，由单盲、三臂、成人RCT组成，主要是La- Tino FQHC初级保健患者有危险药物使用(辅助评分4-26)，随机分为3种情况 (n=320/ARM，共960例)：1)戒烟-移动；2)标准戒烟；3)常规护理。关于实施的定性数据- 除成本数据和成本效益外，促进者和障碍将为未来的扩展和可持续性提供信息 竞争力分析。其目的是检查减少危险药物使用的有效性和成本效益。 比较3个月、6个月和12个月的三个手臂。药物使用措施包括尿液药物测试和时间表 过去7天和过去30天的跟踪自我报告(高风险吸毒者有零星的吸毒模式 要求对尿检可能检测不到的药物使用情况进行更长的自我报告召回)。三臂研究实现了 测试戒烟-Mobile与戒烟以及两者与常规护理的独立和协同效应， 认识到在临床/指导关系之外，仅有mHealth组件可能不会有效。 12个月的时间表反映了筛查时每年初级保健就诊的预期扩大情景 短暂的干预将会照例重复。Quit包含3个组件：1)使用 世卫组织协助，2)简短的临床医生建议(&lt；4分钟)，包括阿片类药物过量预防教育，以及3)2 以及为期6周的电话戒毒健康辅导课程，利用激励性访谈和认知能力- 行为技巧，由准职业健康教练传授。Quit-Mobile提议测试这一添加功能 移动电话自我监控、反馈和教练监控仪表板，以增强和维持戒烟 使用移动应用程序、短信(SMS)或交互式语音应答(IVR)减少药物使用，从而实现 通过不同的技术偏好来解放。这项研究没有测试哪种技术平台更多 有效而不是干预功能的有效性(即，自我监控，自动反馈， 教练监控)，通过患者首选的技术提供。这项研究在国际上是新颖和及时的。 将可大规模扩展的移动电话工具整合到有效的初级保健BI中，以防止物质使用障碍- 由准专业人员接生的FQHC患者的DER(SUD)。Quit-Mobile对国家阿片类药物做出反应 危机，以及美国精神卫生平等法和国家医学院整合的建议 行为健康SBs被纳入初级保健环境，以防止需要专门治疗的更高水平的SUD。

PROJECT SUMMARY. The QUIT-Mobile study proposes to use mobile phone self-monitoring and feedback to enhance and sustain over 12-months the impacts of the Quit Using Drugs Intervention Trial (QUIT), an ef- fective screening and brief intervention (SBI) previously successful in reducing risky drug use (i.e., moderate use) in low-income, diverse patients over a 3-month follow up. We propose to conduct the QUIT-Mobile study for primary care patients who receive care in 8 clinics of federally qualified health centers (FQHC) in Southern California over 12-months follow up, comparing to QUIT and Usual Care (UC). The proposed study is an Effec- tiveness-Implementation Hybrid Type 1 design consisting of a single-blind, 3-arm, RCT with adult, mostly La- tino FQHC primary care patients with risky drug use (ASSIST score 4-26), randomized to 3 conditions (n=320/arm, n=960 total): 1) QUIT-Mobile; 2) standard QUIT; 3) Usual Care. Qualitative data on implementa- tion facilitators and barriers will inform future scale-up and sustainability, in addition to cost data and cost-effec- tiveness analysis. The aims are to examine effectiveness in reducing risky drug use and cost-effectiveness comparing the three arms over 3-, 6- and 12-months. Drug use measures include urine drug tests, and timeline follow-back self-reports for past 7-days and past 30-days (risky drug users have sporadic drug use patterns requiring longer self-report recalls for drug use that urine screens may not detect). The 3-arm study enables testing of the independent and synergistic effects of QUIT-Mobile compared to QUIT and both to Usual Care, acknowledging that mHealth components alone may not be effective outside of a clinical/coaching relationship. The 12-month timeline reflects anticipated scale-up scenarios of annual primary care visits when screening and brief intervention would be repeated routinely. QUIT contains 3 components: 1) patient screening with the WHO ASSIST, 2) brief clinician advice (<4 minutes) including opioid overdose prevention education, and 3) 2- and 6-week telephone drug-use health coaching sessions utilizing motivational interviewing and cognitive be- havioral techniques, delivered by paraprofessional health coaches. QUIT-Mobile proposes to test the addition of mobile phone self-monitoring, feedback, and coach monitoring dashboard to enhance and sustain QUIT's drug use reductions using mobile app, text-messaging (SMS), or interactive voice response (IVR) to allow par- ticipation by with varying technological preferences. This study does not test which technology platform is more effective, but rather, the effectiveness of the intervention functions (i.e., self-monitoring, automated feedback, coach monitoring) that are delivered via patients' preferred technologies. This study is novel and timely in inte- grating massively scalable mobile phone tools into an effective primary care BI to prevent substance use disor- der (SUD) in FQHC patients delivered by paraprofessionals. QUIT-Mobile is responsive to the National Opioid Crisis, and the US Mental Health Parity Act and National Academy of Medicine recommendations to integrate behavioral health SBIs into primary care settings to prevent higher level SUD requiring specialty treatment.