title: A randomized clinical trial of the health evaluation and referral assistant (HERA): research methods.
abstract: The Health Evaluation and Referral Assistant (HERA) is a web-based program designed to facilitate screening, brief intervention, and referral to treatment (SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance abuse assessment, the HERA produces a summary report with evidence-based recommended clinical actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the Patient Feedback Report) that provides education regarding the consequences of use, personally tailored motivational messages, and a tailored substance abuse treatment referral list. For those who provide authorization, the HERA faxes the individual's contact information to a substance abuse treatment provider matched to the individual's substance use severity and personal characteristics, like insurance and location of residence (dynamic referral). This paper summarizes the methods used for a randomized controlled trial to evaluate the HERA's efficacy in leading to increased treatment initiation and reduced substance use. The study was performed in four emergency departments. Individual patients were randomized into one of two conditions: the HERA or assessment only. A total of 4269 patients were screened and 1006 participants enrolled. The sample was comprised of 427 tobacco users, 212 risky alcohol users, and 367 illicit drug users. Forty-two percent used more than one substance class. The enrolled sample was similar to the eligible patient population. The study should enhance understanding of whether computer-facilitated SBIRT can impact process of care variables, such as promoting substance abuse treatment initiation, as well as its effect on subsequent substance abuse and related outcomes.
authors.affiliation: The Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Edwin.Boudreaux@umassmed.edu
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.forename: Beau
authors.initials: B
authors.lastname: Abar
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.forename: Grant
authors.initials: G
authors.lastname: Grissom
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012017:Referral and Consultation; D012107:Research Design; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D017216:Telemedicine / Q000379:methods*; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000628:therapy
keywords: Brief intervention; E-health; Referral; Substance abuse screening; Substance abuse treatment; Treatment matching