O'Grady Megan A, Kapoor Sandeep, Harrison Laura, Kwon Nancy, Suleiman Adekemi O, Muench Frederick J
Department of Public Health Sciences, School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT, 06030-6325, USA.
Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
Implement Sci Commun. 2022 Aug 6;3(1):86. doi: 10.1186/s43058-022-00333-y.
Unhealthy alcohol use (UAU) is a leading cause of premature mortality among adults in the USA. Emergency departments (EDs) are key intervention settings for UAU but often have limited time and resources. One low-burden, scalable approach to address UAU is text-messaging interventions. Despite strong research support and promise for scalability, there is little research on how to implement such interventions in healthcare settings. The process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows and patients adopting them remains a new area of research. The purpose of this three-phase study is to develop and test an implementation strategy for UAU text-messaging interventions in EDs.
Our first aim is to examine barriers and facilitators to staff offering and patients accepting a text-messaging intervention in the ED using an explanatory, sequential mixed methods approach. We will examine alcohol screening data in the electronic health records of 17 EDs within a large integrated health system in the Northeast and conduct surveys among chairpersons in each. This data will be used to purposively sample 4 EDs for semi-structured interviews among 20 clinical staff, 20 patients, and 4 chairpersons. Our second aim is to conduct a stakeholder-engaged intervention mapping process to develop a multi-component implementation strategy for EDs. Our third aim is to conduct a mixed method 2-arm cluster randomized pilot study in 4 EDs that serve ~11,000 UAU patients per year to assess the feasibility, acceptability, and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services framework will guide study activities.
Low-burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy and will prepare for a larger, fully powered hybrid effectiveness-implementation trial. Findings may also be broadly applicable to implementation of patient-facing mobile health technologies.
This study was registered at ClinicalTrials.gov (NCT05350878) on 4/28/2022.
在美国，不健康饮酒（UAU）是成年人过早死亡的主要原因之一。急诊科（EDs）是针对UAU的关键干预场所，但往往时间和资源有限。一种低负担、可扩展的解决UAU的方法是短信干预。尽管有强有力的研究支持且具有可扩展性的前景，但关于如何在医疗环境中实施此类干预的研究却很少。在已经繁忙且负担过重的急诊科工作流程中，医护人员以高效方式向患者提供短信干预以及患者采用这些干预措施的过程仍是一个新的研究领域。这项三阶段研究的目的是开发并测试一种针对急诊科UAU短信干预的实施策略。
我们的首要目标是使用一种解释性的、序贯混合方法来研究急诊科工作人员提供短信干预以及患者接受该干预的障碍和促进因素。我们将研究东北部一个大型综合医疗系统内17个急诊科电子健康记录中的酒精筛查数据，并对每个科室的主任进行调查。这些数据将用于有目的地抽取4个急诊科，对20名临床工作人员、20名患者和4名主任进行半结构化访谈。我们的第二个目标是开展一个利益相关者参与的干预映射过程，以制定针对急诊科的多组件实施策略。我们的第三个目标是在每年服务约11,000名UAU患者的4个急诊科中进行一项混合方法双臂整群随机试点研究，以评估实施策略的可行性、可接受性和初步有效性。卫生服务研究实施综合促进行动框架将指导研究活动。
像短信这样的低负担技术，以及由已确定的障碍和促进因素驱动的有针对性的实施支持和策略，可以维持基于急诊科的大规模酒精筛查项目，并为筛查呈阳性的患者提供急需的支持，同时减轻急诊科的负担。拟议的研究将是首个开发并测试这种有针对性的实施策略的研究，并将为更大规模、充分有力的混合有效性 - 实施试验做好准备。研究结果可能也广泛适用于面向患者的移动健康技术的实施。
本研究于2022年4月28日在ClinicalTrials.gov（NCT05350878）注册。
