Bannon Jennifer, Smith Justin D, Van Ryzin Mark J, McHugh Megan, Heinrich Jennifer, Walunas Theresa L, Kho Abel N
Division of General Internal Medicine and Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA.
Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA.
Contemp Clin Trials Commun. 2024 Dec 9;43:101413. doi: 10.1016/j.conctc.2024.101413. eCollection 2025 Feb.
Unhealthy alcohol use is a leading cause of preventable mortality and a risk factor for an array of social and health problems. The Intervention in Small primary care Practices to Implement Reduction in unhealthy alcohol use (INSPIRE) study is part of a nationwide campaign to improve the identification and treatment of patients engaging in unhealthy alcohol use.
We conducted a single arm, pragmatic study consisting of seventeen primary care practices in the Chicago metropolitan area, Wisconsin, and California across two waves with a 6-month latent period, a 12-month intervention period, followed by a 6-month sustainability period. Enrolled practices were independent, Federally Qualified Health Centers, network-based, and academic health centers. INSPIRE utilized the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to examine implementation feasibility, fidelity, and performance of clinicians on practice adoption of screening, brief intervention, referral to treatment (SBIRT) and medication for unhealthy alcohol use (MAUD) activities in primary care clinics.
Seventeen eligible primary care practices were enrolled over the course of 21 months beginning in March of 2020 through December of 2021. There was a pause in recruitment from March of 2020 through July of 2020 due to the Covid-19 pandemic. The majority of enrolled practices were small (<6 clinicians) and were part of a network. 57 % of clinicians completed the educational modules in part or in full.This paper will outline the INSPIRE protocol and design. Additionally, we will present practice demographic data, recruitment data and results related to on-line learning module completion.
The INSPIRE study will evaluate the ability of primary care clinicians in small practices to participate in practice education programs and implement standard screening and treatment protocols, adapted for documentation in the electronic health record (EHR). The study will also identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods.
不健康饮酒是可预防死亡的主要原因，也是一系列社会和健康问题的风险因素。初级保健实践中减少不健康饮酒干预（INSPIRE）研究是全国性运动的一部分，旨在改善对不健康饮酒患者的识别和治疗。
我们进行了一项单臂实用研究，该研究包括芝加哥大都市地区、威斯康星州和加利福尼亚州的17家初级保健机构，分两波进行，有6个月的潜伏期、12个月的干预期，随后是6个月的可持续期。入选的机构为独立的联邦合格健康中心、基于网络的机构和学术健康中心。INSPIRE利用RE-AIM（覆盖范围、有效性、采用率、实施情况、维持情况）框架来检验初级保健诊所中临床医生在采用筛查、简短干预、转介治疗（SBIRT）和针对不健康饮酒的药物治疗（MAUD）活动方面的实施可行性、保真度和表现。
从2020年3月到2021年12月的21个月期间，共有17家符合条件的初级保健机构参与。由于2019冠状病毒病疫情，2020年3月至7月招募工作暂停。大多数入选的机构规模较小（<6名临床医生），且是网络的一部分。57%的临床医生部分或全部完成了教育模块。本文将概述INSPIRE方案和设计。此外，我们还将展示机构人口统计学数据、招募数据以及与在线学习模块完成情况相关的结果。
INSPIRE研究将评估小型初级保健临床医生参与实践教育项目并实施适用于电子健康记录（EHR）记录的标准筛查和治疗方案的能力。该研究还将使用定量和定性分析方法确定促进或阻碍改善及可持续性的因素。
