Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Addiction Science & Clinical Practice

卷:12

Daniel R. Kivlahan¹  Diane M. Greenberg¹  Andrew J. Saxon¹  Eric Hawkins¹  Joseph O. Merrill²  Laura J. Chavez³  Carol E. Achtmeyer⁴  Emily C. Williams⁵  Rachel M. Thomas⁵  Susan J. Ruedebusch⁵  Ryan M. Caldeiro⁶  Gwen Lapham⁶  Amy K. Lee⁶  Theresa E. Matson⁶  Julie E. Richards⁶  Evette Joy Ludman⁶  Katharine A. Bradley⁶  Jennifer F. Bobb⁶ 

[1] Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System;

[2] Department of Medicine, University of Washington;

[3] Division of Health Services Management and Policy, College of Public Health, The Ohio State University;

[4] General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System;

[5] Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care;

[6] Kaiser Permanente Washington Health Research Institute;

关键词: Shared decision making;    Alcohol use disorder;    Care management;    Brief interventions;    Chronic Care Model;    Patient-centered care;   

DOI  :  10.1186/s13722-017-0080-2

来源: DOAJ

【 摘 要 】

Abstract Background Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample. Methods The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs. Results A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale. Conclusion The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).

【 授权许可】

Unknown