Brief Intervention for Drug Misuse for the Emergency Department (BIDMED)

描述（由申请人提供）：尽管筛查、短暂干预和转诊治疗（SBIRT）方法可有效减少酒精滥用及其相关的冒险行为和负面后果，但很少有研究证明SBIRT对非法和/或处方药滥用的有效性。非法和/或处方药滥用者经常在急诊室寻求医疗护理，特别是出于与滥用药物有关的原因。因此，艾德非常适合作为一个网站进行SBIRT的有效性分析，为这一人群。急诊科药物滥用的短期干预（BIDMED）研究是一项随机、对照试验，将纳入大型学术创伤中心（罗得岛医院）和社区医院（Miriam医院）的成人艾德患者，这些患者患有亚危重疾病或损伤，其筛查显示非法和/或处方药滥用。BIDMED受试者将随机接受仅筛选（SO）或简短干预（BI），并适当转诊至治疗。受试者将使用标准化工具以及针对本研究目的的适用工具完成一系列设盲基线评估。所有受试者将在随机化后3个月、6个月和12个月接受盲态随访评估。BIDMED研究中提出的主要假设是，与SO组受试者相比，BI组受试者在以下方面的减少显著更大：（1）随机化后3个月前30天内的药物滥用，（2）随机化后6个月与药物滥用相关的行为;和（3）随机分组后12个月时的负面身体健康、心理健康和社会经济后果。作为次要目的，将评估BI与SO相比对联系、入组和完成药物治疗计划的受试者的影响。此外，还将测量BI与SO相比对增加HIV和B/C型肝炎筛查摄取的影响。还将开发和测试一个机制的变化模型，解决预期的调解人和主持人的变化，以解释SBIRT在这种情况下的影响。此外，将在艾德患者的随机样本中评估非法和/或处方药滥用的流行病学。公共卫生相关性：鉴于紧急医疗护理和药物滥用的交叉点，如果SBIRT对这一人群有效，则艾德可以作为减少药物滥用公共卫生问题的重要贡献者。在艾德进行药物滥用的SBIRT有可能在艾德就诊期间的“可教时刻”接触到可能与药物滥用有关的人。

DESCRIPTION (provided by applicant): Although screening, brief intervention, and referral to treatment (SBIRT) approaches are effective in reducing alcohol misuse and its associated risk-taking behaviors and negative consequences, there is little research demonstrating the effectiveness of SBIRT for illicit and/or prescription drug misuse. Misusers of illicit and/or prescription drugs frequently seek medical care in emergency departments (EDs), particularly for reasons related to their misuse. As a result, the ED is well suited as a site to conduct an analysis of the effectiveness of SBIRT for this population. The Brief Intervention for Drug Misuse for the Emergency Department (BIDMED) study is a randomized, controlled, trial that will include adult ED patients at a large, academic, trauma center (Rhode Island Hospital) and a community hospital (The Miriam Hospital) who have a subcritical illness or injury and whose screening indicates illicit and/or prescription drug misuse. BIDMED participants will be randomized to receive screening only (SO) or brief intervention (BI) with appropriate referral to treatment. Participants will complete a battery of blinded baseline assessments using standardized instruments as well as adapted instruments specific to the aims of this study. All participants will undergo blinded follow-up assessments at three, six, and twelve months post-randomization. The primary hypotheses addressed in the BIDMED study are that, compared to participants in the SO arm, participants in the BI arm will show a significantly greater reduction in: (1) drug misuse within the prior 30 days at three months post-randomization, (2) behaviors associated with drug misuse at six months post-randomization; and (3) negative physical health, psychosocial health, and socioeconomic consequences at twelve months post-randomization. As a secondary aim, the impact of BI compared to SO will be assessed on participants contacting, enrolling in, and completing a drug treatment program. In addition, the impact of BI compared to SO on increasing uptake of HIV and hepatitis B/C screening will be measured. A mechanisms of change model that addresses the expected mediators and moderators of change to explain the effects of SBIRT in this setting will also be developed and tested. Further, the epidemiology of illicit and/or prescription drug misuse will be assessed in a random sample of ED patients. PUBLIC HEALTH RELEVANCE: Given the intersection of emergency medical care and drug misuse, the ED could serve as a significant contributor in reducing the public health problem of drug misuse if SBIRT is shown to be effective for this population. SBIRT in the ED for drug misuse has the potential for reaching people during a "teachable moment" during an ED visit that might be related to drug misuse.