Remote Brief Intervention and Referral to Treatment Service for Alcohol (R-BIRT)

DESCRIPTIONprovided by applicantSignificanceThe USPHSTFSAMHSACDCand NIAAA have affirmed the importance of screening in medical settings for alcohol consumption that exceeds the NIAAA low risk limitsbrief educational and motivational counseling for those who screen positive or have other evidence of an Alcohol Use Disorderandwhen appropriatereferral to treatmentSBIRTHowevertranslation to clinical practice continues to be elusivePolaris Health DirectionsSmall Businessand the University of Massachusetts Medical SchoolResearch Institutehave partnered to solve this problem by creating the Remote Brief Intervention and Referral to Treatment service for alcoholR BIRTa telehealth service for delivering evidence based alcohol brief interventions and referral to treatment during a medical encounter in a cost effectivesustainable wayInvestigatorsWe have extensive expertise in SBIRT for alcoholBoudreauxBernsteintelehealthBoudreauxdevelopmenttestingand marketing of behavioral intervention technologiesBoudreauxHarralsonGrissomcomparative effectiveness trial design and analysisBartonand health economicsSachsCombinedthe team has overpublications related to SBIRT and constituent technology domainsInnovationThis Phase II STTR will pioneer telehealth delivery of SBIRT for alcoholIt will be flexible enough for a variety of medical settingsand will develop and expand software capable of facilitating both telehealth and in person SBIRT delivery modelsIt will further innovate SBIRT research and clinical practice by exploring mechanisms of actionan objective rarely incorporated into SBIRT studiesApproachThe design is a two armsingle blindoutcomes assessorrandomizednon inferiority trialEmergency departmentEDpatientsnwho drink above the NIAAA low risk limits or have evidence of an Alcohol Use Disorder will be randomized to the telehealth modelR BIRTor a gold standard in person interventionSBIRTand followed formonths post visit using a multi method outcomes attainment planThe study will establish the non inferiority of the telehealth model compared to the in person model in reducing alcohol use and alcohol related consequenceswhile showing that the telehealth model is the more cost effective of the twoMechanisms of actionincluding patient knowledge of low risk drinking limitsmotivationself efficacysubstance abuse treatment initiationand self help program engagementwill be examinedEnvironmentWith the success of the R BIRT Phase I and other relevant projectsincluding previous large scale Phase II STTR clinical trialsPolaris and UMass have clearly established their capability of successfully carrying out this studydisseminating its resultsand marketing the final productImpactBecause alcohol misuseabuseand dependence carries an enormous burden in both human suffering and healthcare costsa strategy that provides high qualityevidence based care in a manner that is more cost effective and easier than existing models has potential to exert a substantial impact on public health PUBLIC HEALTH RELEVANCEThe traditional paradigm that relies upon training physicians and nurses or uses on site interventionists to perform screeningbrief interventionand referral to treatmentSBIRTfor alcohol has proven unsustainable in most clinical settingsThe Remote Brief Intervention and Referral to TreatmentR BIRTfor alcohol is an innovative telehealth service model with potential to improve public health through evidence based counseling for patients who exceed the NIAAA low risk drinking limits or have evidence of an Alcohol Use Disorder with professional and self help treatmentFor those that are appropriatethe R BIRT service will provide facilitated referrals to specialized alcohol abuse treatmentThe service model is being studied in the emergency departmentEDsetting to demonstrate its utility in a medical setting with a very high prevalence of risky alcohol use and Alcohol Use Disordershoweverthe model is relevant and will be accessible to a broad array of healthcare settingsincluding primary care practicesOur new modelthe R BIRTchallenges the prevailing paradigm and offers the promise of not only clinical efficacy but increased cost effectiveness as well