Screening för ungdomars alkohol- och droganvändning: En studie av primärvårdsgivare
14 juli 2023 uppdaterad av: Kaiser Permanente
Denna studie utvärderar implementeringen och effektiviteten av två metoder för screening, kort intervention och behandling (SBIRT) för att minska användningen av alkohol och andra droger hos ungdomar på en stor pediatrisk klinik.
Studieöversikt
Status
Aktiv, inte rekryterande
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Hälsosystem har inte implementerat screening, kort ingripande och behandlingshänvisning (SBIRT) för ungdomar trots att forskning har visat dess effektivitet.
Baserat på tidigare forskning som identifierade hinder för AOD-screening för ungdomar i pediatrisk primärvård (PC) och en pilotstudie som fann att SBIRT var genomförbart, väl mottagna och främjade remisser till och initiering av specialbehandling, föreslår den aktuella forskningsansökan att randomisera 45 Primary Care Physicians (PCPs) i pediatriska kliniken på ett medicinskt center inom ett stort, hanterat vårdsystem, Kaiser Permanente Northern California, till tre armar - 1) Vanlig vård; 2) SBIRT levererat av PCP; och 3) SBIRT levererat av Behavioural Medicine Specialists (BMS).
Studiens mål är att jämföra implementeringen, effektiviteten och kostnadseffektiviteten av SBIRT för ungdomar i PC i de tre studiearmarna.
Patienterna kommer att genomföra evidensbaserad screening och AOD-bedömningsåtgärder som har inbäddats i hälsoplanens elektroniska journal (EMR).
En blandad modell kommer att användas för att jämföra implementeringsresultat (hastigheter av screening och identifiering, kort intervention, remiss till behandling med kemiskt beroende och behandlingsstart) och effektivitet (patientresultat av AOD-användning och abstinens) efter 12 månader.
Modellen står för korrelationerna inom klassen mellan patienter inom vårdgivare.
Kostnadseffektivitet i förhållande till implementering och patientresultat kommer att undersökas.
Hinder och underlättar implementering, och genomförbarhet via kvalitativa intervjuer med kliniker och administratörer kommer också att undersökas.
Studien är betydelsefull eftersom den undersöker frågor som måste åtgärdas för att stimulera en omfattande anpassning av SBIRT.
De föreslagna insatserna är mycket genomförbara i den nuvarande miljön för hälsoreformer på grund av ökade resurser och utbildning till federalt kvalificerade hälsocenter och privata hälsoplaner.
Det är innovativt i att använda EMR för att förändra klinisk praxis och systematiskt integrera AOD i PC, och som en plattform för insamling av forskningsdata.
Studietyp
Interventionell
Inskrivning (Faktisk)
9084
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studieorter
-
-
California
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Oakland, California, Förenta staterna, 94612
- Stacy A Sterling
-
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Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
12 år till 80 år (Barn, Vuxen, Äldre vuxen)
Tar emot friska volontärer
Ja
Beskrivning
Det finns två studiepopulationer som beskrivs nedan, alltså det stora åldersgränsintervallet.
Inklusionskriterier:
- Alla primärvårdare för ungdomar vid den pediatriska primärvårdsmottagningen kommer att inkluderas.
- Alla elektroniska journaler för ungdomar, 12-18 år, vid den pediatriska primärvården kommer att granskas.
Exklusions kriterier:
- Alla vårdgivare för ungdomar som inte praktiserar på den pediatriska primärvårdsklinikens forskningsplats kommer att uteslutas.
- Ungdomars elektroniska register som inte är en del av forskningsplatsen för barnkliniken kommer att exkluderas.
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Undersökning
- Tilldelning: Randomiserad
- Interventionsmodell: Faktoriell uppgift
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
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Experimentell: Primärvårdsläkare
Om tonåringen identifieras i riskzonen för droganvändning görs screening och kort interventionshänvisning till den behandling som ges av primärvårdsläkaren
|
Screeningen, kort intervention och remiss till behandling utförs av primärvårdsläkaren
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Experimentell: Beteendemedicinsk specialist
Om tonåringen identifieras i riskzonen för droganvändning, screening och kort interventionsremiss till behandling som ges av specialisten i beteendemedicin
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Screeningen, den korta interventionen och remissen till behandling utförs av Beteendemedicinsk Specialist.
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Inget ingripande: Vanlig vård
Vården ges som vanligt
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Screeningshastighet
Tidsram: Initial screening rate - vid index välbesök
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Andelen patienter som screenas med Teen Well Check Questionnaire AOD-användning eller humörsymtomfrågor, bland alla patienter med Teen Well Check Questionnaire.
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Initial screening rate - vid index välbesök
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Problemidentifieringsgrad
Tidsram: Initial problemidentifiering - vid index välbesök, efter screening
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Andelen screenade patienter som svarar "ja" på AOD-användning eller humörsymtom under de senaste 12 månaderna och "ja" på minst en CRAFFT-fråga utanför bilen.
(Att sitta i en bil med någon som använder AOD kanske inte är relaterat till barnets problem, utan till att ha en förälder/annan vuxen som har kört medan han druckit/använt).
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Initial problemidentifiering - vid index välbesök, efter screening
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Bedömningsgrad
Tidsram: Inom 2 veckor efter index välbesöksdatum
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Andel patienter som screenar positivt för alkohol eller andra droger, eller psykisk hälsorisk, som utvärderas vidare med hjälp av CRAFFT-verktyget.
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Inom 2 veckor efter index välbesöksdatum
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Kort interventionsfrekvens
Tidsram: Inom 14 dagar efter bedömning vid indexbrunnsbesök
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Andelen patienter som får en intervention inom 14 dagar, bland de som identifieras med AOD-risk (baserat på CRAFFT-poäng).
Dokumenterad i EPJ av kliniker, med hjälp av en ICD-9 administrativ V-kod för missbruksrådgivning eller beteenderådgivning.
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Inom 14 dagar efter bedömning vid indexbrunnsbesök
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Remiss till specialbehandlingstakt
Tidsram: Inom 6 månader efter index välbesök
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Andelen patienter som får remisser till specialiserad beteendevårdsbehandling, bland dem som identifierats genom CRAFFT som behov av sådan behandling.
Dokumenterat i EPJ.
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Inom 6 månader efter index välbesök
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Initiering av specialitetsbeteende hälsobehandling
Tidsram: Inom 2 år efter intervention
|
Definieras som den procent som hänvisas till, som har minst ett beteendevårdsbesök med specialitet bland dem som identifierats med ett beteendemässigt hälsoproblem.
Dokumenterat i EPJ.
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Inom 2 år efter intervention
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Användning av alkohol och andra droger
Tidsram: Används under de senaste 6 månaderna, 1 och 2 år efter intervention
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Alkohol- och droganvändning: Föremålen i EHR mäter användning av alkohol, marijuana och andra droger och tobak under 30 dagar och 6 månader, inklusive dagars användning, konsumerad kvantitet (valfri, 3+ och 5+ drycker) och dagar av berusningsdrickande (3+ och 5+).
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Används under de senaste 6 månaderna, 1 och 2 år efter intervention
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Substansanvändningsrelaterade utfall
Tidsram: under de senaste 6 månaderna, 1 och 2 år efter intervention
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AOD-relaterade juridiska, skola och familjeproblem: EHR-frågorna inkluderar också åtgärder från Comprehensive Adolescent Severity Inventory (CASI),148, ett semi-strukturerat frågeformulär som mäter ungdomars hälsa och funktion över utbildnings-, juridiska och familjerelaterade domäner.
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under de senaste 6 månaderna, 1 och 2 år efter intervention
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Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Sponsor
Publikationer och användbara länkar
Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.
Allmänna publikationer
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Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
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Studiestart (Faktisk)
1 oktober 2011
Primärt slutförande (Faktisk)
1 oktober 2013
Avslutad studie (Beräknad)
31 december 2025
Studieregistreringsdatum
Först inskickad
20 mars 2015
Först inskickad som uppfyllde QC-kriterierna
31 mars 2015
Första postat (Beräknad)
6 april 2015
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
18 juli 2023
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
14 juli 2023
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1 juli 2023
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