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

NCT ID: NCT02408952

Last Updated: 2023-07-18

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 9084 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-10-31
• Study Completion Date: 2025-12-31

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.

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.

Conditions

Substance Related Disorders

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: SCREENING
• Blinding Strategy: NONE

Study Groups

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

Group Type: EXPERIMENTAL

Primary Care Physician

Intervention Type: BEHAVIORAL

The screening, brief intervention and referral to treatment is delivered by the Primary Care Physician

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

Group Type: EXPERIMENTAL

Behavioral Medicine Specialist

Intervention Type: BEHAVIORAL

The screening, brief intervention and referral to treatment is delivered by the Behavioral Medicine Specialist.

Usual Care

Care is administered as usual

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Primary Care Physician

The screening, brief intervention and referral to treatment is delivered by the Primary Care Physician

Intervention Type: BEHAVIORAL

Behavioral Medicine Specialist

The screening, brief intervention and referral to treatment is delivered by the Behavioral Medicine Specialist.

Intervention Type: BEHAVIORAL

Eligibility Criteria

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.

• Minimum Eligible Age: 12 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Kaiser Permanente

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Stacy A Sterling

Oakland, California, United States

Countries

United States

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Other Identifiers

11-07796

Identifier Type: -

Identifier Source: org_study_id