Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240-1001, USA.
Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA.
Addict Sci Clin Pract. 2022 Mar 14;17(1):19. doi: 10.1186/s13722-022-00300-x.
Alcohol use is a significant risk factor for disability and death in U.S. adults, and approximately one out of every six Veterans seen in primary care (PC) report unhealthy alcohol use. Unhealthy alcohol use is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA pioneered implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. To improve alcohol-related care, this study will conduct a pilot study to assess whether a multi-faceted evidence-based implementation strategy-practice facilitation-has the potential to improve PC-based alcohol-related care at a single VA clinic.
We will first recruit and conduct qualitative interviews with Veterans with unhealthy alcohol use (n = 20-25) and PC stakeholders (N = 10-15) to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the multifaceted practice facilitation intervention. Qualitative interviews, analysis, and refinement of the intervention will be guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups with a small sample of PC providers and staff (n = 5-7) will be used to further refine the practice facilitation intervention and assess its acceptability and feasibility. The refined practice facilitation intervention will then be offered in the PC clinic to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes based on the RE-AIM framework.
This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. If successful, this pilot may generate an intervention with far-reaching effects on adverse outcomes experienced by Veterans with unhealthy alcohol use, including increased access to care and suicide prevention. Trial registration Clinicaltrials.gov identifier: NCT04565899; Date of registration: 9/25/2020.
在美国成年人中，饮酒是残疾和死亡的一个重要风险因素，大约每六位在初级保健 (PC) 就诊的退伍军人中就有一位报告饮酒不健康。饮酒不健康与不良医疗结果、巨大的社会成本和死亡风险（包括自杀）相关。基于随机对照试验和美国预防服务工作组的大量证据，VA/DoD 临床指南规定，所有在 PC 中筛查出饮酒不健康的退伍军人都应接受基于证据的酒精护理，包括简短的咨询干预 (BI) 和对有酒精使用障碍 (AUD) 的人的额外治疗（例如，药物治疗）。VA 率先在 PC 中实施酒精筛查和 BI，但仍存在大量实施差距。为了改善与酒精相关的护理，本研究将进行一项试点研究，以评估多方面基于证据的实施策略——实践促进——是否有可能改善单个 VA 诊所的基于 PC 的与酒精相关的护理。
我们将首先招募并对饮酒不健康的退伍军人 (n=20-25) 和 PC 利益相关者 (n=10-15) 进行定性访谈，以了解高质量酒精护理的障碍和促进因素，并利用结果来完善和磨练多方面的实践促进干预措施。定性访谈、分析和干预措施的完善将由实施研究综合框架 (CFIR) 指导。将使用 PC 提供者和工作人员的小样本 (n=5-7) 的焦点小组进一步完善实践促进干预措施，并评估其可接受性和可行性。然后，将在 PC 诊所提供经过改进的实践促进干预措施，以根据 RE-AIM 框架评估实施 (例如，覆盖范围) 和有效性 (减少饮酒) 结果。
这项研究直接针对我们这个时代最大的公共卫生危机之一，因为酒精导致的死亡人数超过了阿片类药物，而且与自杀风险增加有关。如果成功，该试点可能会产生一种干预措施，对饮酒不健康的退伍军人的不良后果产生深远影响，包括增加获得护理和预防自杀的机会。
Clinicaltrials.gov 标识符：NCT04565899；注册日期：2020 年 9 月 25 日。
