A Stage-Based Tailored Support Tool for Alcohol Counsel

DESCRIPTION (provided by applicant): Alcohol-related problems are costly, but not routinely addressed in primary care where 100+ million people receive their usual source of care. Moreover patients are motivated to act on the health behavior advice of their primary care physicians. We propose to develop a state-of-the-art computer software application to enhance clinician effectiveness in diagnosing and intervening with problem drinkers. The Alcohol Misuse Intervention Tool (AMIT) will be a clinical decision support tool for Personal Digital Assistants (PDAs) and other mobile platforms. AMIT will distill recommended guidelines and evidence based practices into a practical, streamlined, patient tailored, electronic resource that is easy to use, intuitive, and rapidly accessible to busy clinicians at the point of care. Algorithms supporting the tool will be developed using the concept of Information Mastery (Shaughnessy, Slawson,& Bennet, 1994) and will rely on evidence based practice guidelines; motivational interviewing (Miller, 1996); and the Transtheoretical Model of health behavior change (Prochaska & DiClemete, 1983). The commercial version of AMIT will automatically seek and download updates via the Internet in order to ensure that the most current information is available at the point of care. AMIT was conceived in response to the needs identified by NIAAA in the 2005 SBIR/STTR Omnibus Solicitation (DHHS, 2005), which calls for "development and testing of computer algorithms necessary to derive diagnoses of alcohol use disorders" (p. 14) and "selection of appropriate interventions..." (p. 15). Phase I specific aims are to : 1) develop brief evidence-based clinical instruments to assess problem drinking at the point of care; 2) develop a functioning prototype of AMIT, a portable software tool designed to facilitate delivery of those instruments; 3) conduct formal usability testing of the AMIT prototype with health practitioners; 4) measure prototype utilization rates and pre- to post changes in clinician knowledge, behavior, attitudes, and perceived self-efficacy in applying evidence based counseling strategies for unhealthy alcohol use in 20 clinicians who use the AMIT prototype for 3 months. Our long-term commercial goal is to develop a suite of interactive, Internet-distributable, clinical decision support tools, each of which will facilitate evidence-based behavioral change interventions for a specific health issue. Target customers are health plans, HMOs, large hospitals, and research institutions.