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Trial record 4 of 4 for:    12038895 [PUBMED-IDS]

Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers

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ClinicalTrials.gov Identifier: NCT02408952
Recruitment Status : Active, not recruiting
First Posted : April 6, 2015
Last Update Posted : May 3, 2017
Sponsor:
Collaborator:
Kaiser Permanente
Information provided by (Responsible Party):
Constance Weisner, University of California, San Francisco

Brief Summary:
This study evaluates the implementation and effectiveness of two modalities of Screening, Brief Intervention and Referral to Treatment (SBIRT) to reduce adolescent alcohol and other drug (AOD) use in a large pediatrics clinic.

Condition or disease Intervention/treatment Phase
Substance Related Disorders Behavioral: Primary Care Physician Behavioral: Behavioral Medicine Specialist Not Applicable

Detailed Description:
Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize 45 Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care; 2) SBIRT delivered by PCPs; and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiation), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed interventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9084 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Screening
Official Title: Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers
Study Start Date : October 2011
Actual Primary Completion Date : October 2013
Estimated Study Completion Date : June 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Primary Care Physician
If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered is by the primary care physician
Behavioral: Primary Care Physician
The screening, brief intervention and referral to treatment is delivered by the Primary Care Physician

Experimental: Behavioral Medicine Specialist
If the adolescent is identified at risk for substance use, the screening and brief intervention referral to treatment delivered by the behavioral medicine specialist
Behavioral: Behavioral Medicine Specialist
The screening, brief intervention and referral to treatment is delivered by the Behavioral Medicine Specialist.

No Intervention: Usual Care
Care is administered as usual



Primary Outcome Measures :
  1. Screening rate [ Time Frame: Initial screening rate - at index well-visit ]
    The proportion of patients who are screened with the Teen Well Check Questionnaire AOD use or Mood symptom questions, among all patients with Teen well-child visits.

  2. Problem Identification rate [ Time Frame: Initital problem identification rate - at index well-visit, following screening ]
    The proportion of patients screened who answer "yes" to AOD use or Mood symptoms in past 12 months and "yes" to at least one non-car CRAFFT question. (Being in a car with someone using AOD may not be related to child's problem, but to having a parent/other adult who has driven while drinking/using).

  3. Assessment rate [ Time Frame: Within 2 weeks following index well-visit date ]
    Proportion of patients screening positive for alcohol or other drug, or mental health risk, who are assessed further using the CRAFFT tool.

  4. Brief Intervention rate [ Time Frame: Within 14 days of assessment at index well visit ]
    The proportion of patients who receive an intervention within 14 days, among those who are identified with AOD risk (based on CRAFFT score). Documented in EHR by clinicians, using an ICD-9 Administrative V-code for substance use counseling or behavioral counseling.

  5. Referral to specialty treatment rate [ Time Frame: Within 6 months of index well-visit ]
    The proportion of patients who receive referrals to specialty behavioral health treatment, among those identified through the CRAFFT as needing such treatment. Documented in the EHR.


Secondary Outcome Measures :
  1. Specialty Behavioral Health Treatment Initiation [ Time Frame: Within 2 years post-intervention ]
    Defined as the percent referred, who have at least one specialty behavioral health visit among those identified with a behavioral health problem. Documented in the EHR.

  2. Alcohol and other drug use [ Time Frame: Use in past 6 months, at 1 and 2 years post-intervention ]
    Alcohol and drug use: The items in the EHR measure past 30-day and 6-month use of alcohol, marijuana and other drugs and tobacco, including days of use, quantity consumed (any, 3+ and 5+ drinks), and days of binge drinking (3+ and 5+).

  3. Substance Use-related outcomes [ Time Frame: in past 6 months, at 1 and 2 years post-intervention ]
    AOD-related legal, school, and family problems: The EHR questions also include measures from the Comprehensive Adolescent Severity Inventory (CASI),148 a semi-structured questionnaire which measures adolescent health and functioning across education, legal, and family relations domains.



Information from the National Library of Medicine

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Ages Eligible for Study:   12 Years to 80 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

There are two study populations as described below thus the large age limit range.

Inclusion Criteria:

  • All adolescent primary care providers at the pediatric primary care clinic will be included.
  • All adolescent patient electronic records, ages 12-18, at the pediatric primary care will be examined.

Exclusion Criteria:

  • Any adolescent primary care providers not practicing at the pediatric primary care clinic research site will be excluded.
  • Adolescents electronic records who are not part of the research site pediatric clinic will be excluded.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02408952


Locations
United States, California
Stacy A Sterling
Oakland, California, United States, 94612
Sponsors and Collaborators
University of California, San Francisco
Kaiser Permanente

Publications:
Saunders KW, Davis RL, Stergachis A. Group Health Cooperative. In: Strom BL, ed. Pharmacoepidemiology. 4th ed. New York: Wiley, 2005:223-239
Selby JV, Smith DH, Johnson ES, et al. Kaiser Permanente Medical Care Program. In: Strom BL, ed. Pharmacoepidemiology. 4th ed. New York: Wiley, 2005:241-259
Barroso T, Castanhola R, Marta M, et al. Effectiveness of brief alcohol interventions by clinical nurse specialists (CNS) in primary care settings. 2010 ISBRA World Congress, Paris, France, Sep 13-16, 2010
National Institute on Alcohol Abuse and Alcoholism. Five-year strategic plan (FY07-11): Alcohol across the lifespan. Washington, DC: U.S. Department of Health and Human Services, 2006. http://pubs.niaaa.nih.gov/publications/StrategicPlan/NIAAASTRATEGICPLAN.htm. Accessed Oct 18, 2010.
Substance Abuse and Mental Health Services Administration. SAMHSA Report to Congress - Nov 2002. The prevention and treatment of co-occurring substance abuse disorders and mental disorders. Rockville, MD, 2002. http://www.samhsa.gov/reports/congress2002/CoOccurringRpt.pdf. Accessed Oct 25, 2010
Mental Health America. Parity and health care reform: important changes for behavioral health, 2010. http://www.mentalhealthamerica.net/go/action/policy-issues-a-z/healthcare-reform. Accessed Oct 21, 2010
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001
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National Institute on Alcohol Abuse and Alcoholism. Statistical snapshot of underage drinking, 2008. http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm. Accessed Oct 19, 2010
Johnston LD, O'Malley PM, Bachman JG, et al. Monitoring the Future national results on adolescent drug use: Overview of key findings 2004. Bethesda, MD: National Institute on Drug Abuse, 2005. http://www.drugabuse.gov/PDF/overview2004.pdf. Accessed Oct 19, 2009
Underage Drinking Enforcement Training Center. Welcome to the Underage Drinking Enforcement Training Center. http://www.udetc.org/index.asp. Updated Oct 2010. Accessed Oct 27, 2010
Office of National Drug Control Policy. The economic costs of drug abuse in the United States, 1992-2002. Washington, DC: Executive Office of the President (Publication No. 207303), 2004
Sterling S, Weisner C. The role of primary care in addressing adolescent substance use: Screening, treatment, and coordination. Paper presented at the
American Medical Association. Guidelines for Adolescent Preventive Services (GAPS). Chicago: American Medical Association, 1997
Guide to Clinical Preventive Services 2010 - 2011. AHRQ Publication No. 10-05145: Agency for Healthcare Research and Quality, 2010. http://www.ahrq.gov/clinic/pocketgd.htm. Accessed Oct 25, 2010
American Academy of Pediatrics. Periodic survey of fellows: 45% of Fellows routinely screen for alcohol use., 2002. http://aapnews.aappublications.org/cgi/content/short/14/10/1. Accessed April 6, 2009
Barnett NP, Monti PM, Wood MD. Motivational interviewing for alcohol-involved adolescents in the emergency room. . In: Wagner EF, Waldron HB, eds. Innovations in Adolescent Substance Abuse Interventions. Amsterdam, Netherlands: Pergamon/Elsevier Science Inc, 2001:143-168
Kaner E, Bland M, Cassidy P, et al. Screening and brief alcohol intervention in routine primary care In the UK: SIPS trial outcomes at six months. 2010 ISBRA World Congress, Paris, France, Sep 13-16, 2010
Massachusetts Department of Public Health Bureau of Substance Abuse Services. Provider Guide: Adolescent Screening, Brief Intervention, and Referral to Treatment Using the CRAFFT Screening Tool. Boston: Massachusetts Department of Public Health, 2009
Phillips JL, Smithstan P. Brief intervention: An approach for substance abusing adolescents. Trainer and trainee guide. A CARS training program prepared by Joel L. Phillips and Pam Smithstan, MFT, based on the work of Ken Winters, PhD. Santa Rosa, CA: Center for Applied Research Solutions, 2006. http://indianeducation.org/userfiles/file/Session%207_3b%20Brief%20Intervention%20FBecker.pdf
Chi FW, Sterling S, Campbell CI, et al. Twelve-step participation at 5-year follow-up among a diverse sample of adolescents entering chemical dependency treatment. Joint Meeting on Adolescent Treatment Effectiveness (JMATE), Washington, DC, Mar 25-27, 2008
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Constance Weisner, Professor, University of California, San Francisco
ClinicalTrials.gov Identifier: NCT02408952     History of Changes
Other Study ID Numbers: 11-07796
First Posted: April 6, 2015    Key Record Dates
Last Update Posted: May 3, 2017
Last Verified: May 2017

Additional relevant MeSH terms:
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders