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介的机会。尽管SBIRT的组成部分，特别是筛查和简短干预，已被证明是解决初级保健中酒精滥用问题的有效战略，但有关将SBIRT的所有组成部分用于吸毒患者，特别是在急诊科的数据有限。此外，由于EDS的环境往往混乱，在这种情况下采用整个SBIRT模型存在许多后勤和实际障碍。因此，这项拟议的研究将使用带有音频的触摸屏电脑平板电脑进行计算机筛查(约4900名患者)，并将以双因素设计(3x2)测试干预策略。具体地说，在市中心ED中，900名年龄在18-60岁之间的患者在过去3个月内药物使用筛查呈阳性，他们将被随机分为三种基于ED的条件(计算机简短干预-CBI；干预者短暂干预-IBI；增强型日常护理-EUC)和两种将在ED后2个月进行的随访条件(适应性动机增强疗法-AMET；增强型日常护理-EUC)。所有符合药物使用障碍标准的个人将额外获得SBIRT的“转诊治疗”或“RT”部分。分层随机分配[按性别和药物使用障碍的诊断(是/否)]将在所有基于ED和后续情况的基线上进行。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。认识到短期干预对所有使用药物的患者的改变是重要的，但不一定是充分的，拟议研究的主要具体目标将确定在6个月和12个月时，基于即时“现场”的短期干预条件、2个月的跟踪短暂治疗条件以及各种条件的组合对于减少药物使用和改善与健康相关的结果(包括身心健康和艾滋病毒风险行为)的独立有效性。使用最先进的计算机技术进行筛查和简短干预，可能会比亲自筛查和简短干预接触到更多的ED患者。开发高效和有效地优化SBIRT成分的方法对于改善使用药物的患者的结局具有广泛和强大的公共卫生意义。与公共卫生相关：急诊科是个人(特别是穷人和服务不足的人)的独特接触点，否则他们就不会被识别或获得任何关于其药物使用的援助。为使用药物的患者开发高效和有效地改善结果的方法可以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短干预，可能会比亲自筛查和简短干预接触到更多的ED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.