1
|
Tirla L, Sârbescu P, Rusu A. Assessing the effectiveness of psychoeducational interventions on driving behavior: A systematic review and meta-analysis. ACCIDENT; ANALYSIS AND PREVENTION 2024; 199:107496. [PMID: 38359672 DOI: 10.1016/j.aap.2024.107496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
This review aimed to quantitatively summarize the evidence concerning the effectiveness of psychoeducational interventions on driving behavior. A final pool of 138 studies, totaling approximately 97,000 participants, was included in the analyses and covered all types of driving behavior targeted by the interventions. Using a random effects model, significant results were found for almost all driving outcomes, both post-intervention and long-term. The strongest effect was for reducing distracted driving at post-intervention (d = 1.87 [1.12, 2.60], Z = 4.94, p < 0.001). The only non-significant effects were for reducing errors in the long term (d = 0.50 [-0.87, 1.86], Z = 0.71, p = 0.48) and driving under the influence at post-intervention (d = 0.35 [0.00, 0.71], Z = 1.96, p = 0.05). Concerning which type of intervention was more effective, feedback, training and motivational ones appear to work best. Educational interventions show only weak effects, while awareness interventions seem mostly ineffective. Overall, our results show that most interventions can reduce different types of driving behaviors, but there are specific aspects to be considered based on the targeted behavior.
Collapse
|
2
|
Adhikari K, Teare GF, Belon AP, Lee B, Kim MO, Nykiforuk C. Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review. Public Health 2024; 226:237-247. [PMID: 38091812 DOI: 10.1016/j.puhe.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity. STUDY DESIGN This was a rapid review. METHODS We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis. RESULTS Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking. CONCLUSIONS More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.
Collapse
Affiliation(s)
- K Adhikari
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada.
| | - G F Teare
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada
| | - A P Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - B Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - M O Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - C Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| |
Collapse
|
3
|
Bushover BR, Mehranbod CA, Gobaud AN, Branas CC, Chen Q, Giovenco DP, Humphreys DK, Morrison CN. Self-Report Survey Measures of Alcohol-Impaired Driving: A Systematic Review. J Stud Alcohol Drugs 2023; 84:781-790. [PMID: 37096774 PMCID: PMC10600975 DOI: 10.15288/jsad.22-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Alcohol-impaired driving is a major contributor to motor vehicle crash deaths and injury. Many survey studies include self-report measures of alcohol-impaired driving, but no guidance is available to help researchers select from among available measures. The aims of this systematic review were to compile a list of measures that researchers have used previously, to compare performance between measures, and to identify the measures with highest validity and reliability. METHOD Literature searches of PubMed, Scopus, and Web of Science identified studies that assessed alcohol-impaired driving behavior through self-report. The measures from each study and, if available, indices of reliability or validity were extracted. Using the measures' text, we developed 10 codes to group similar measures and compare them. For example, the "alcohol effects" code refers to driving while feeling dizzy or lightheaded after drinking, and the "drink count" code pertains to the number of drinks someone consumed before driving. For measures with multiple items, each item was categorized separately. RESULTS After screening according to the eligibility criteria, 41 articles were included in the review. Thirteen articles reported on reliability. No articles reported on validity. The self-report measures with the highest reliability coefficients contained items from multiple codes, namely alcohol effects and drink count. CONCLUSIONS Self-report alcohol-impaired driving measures with multiple items evaluating distinct aspects of alcohol-impaired driving show better reliability than measures using a single item. Future work investigating the validity of these measures is needed to determine the best approach for conducting self-report research in this area.
Collapse
Affiliation(s)
- Brady R. Bushover
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Christina A. Mehranbod
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ariana N. Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Daniel P. Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - David K. Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| |
Collapse
|
4
|
Bruguera P, Barrio P, Manthey J, Oliveras C, López-Pelayo H, Nuño L, Miquel L, López-Lazcano A, Blithikioti C, Caballeria E, Matrai S, Rehm J, Vieta E, Gual A. Mid and long-term effects of a SBIRT program for at-risk drinkers attending to an emergency department. Follow-up results from a randomized controlled trial. Eur J Emerg Med 2021; 28:373-379. [PMID: 33709997 DOI: 10.1097/mej.0000000000000810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND IMPORTANCE SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed encouraging results, with more than a 20% greater reduction of at-risk drinking in the intervention group and more than double of successful referrals to specialized treatment. OBJECTIVE We aimed to evaluate the mid and long-term efficacy of an SBIRT program conducted by psychiatrist specialists in addictive disorders and motivational interviewing in the ED of a tertiary hospital. DESIGN, SETTINGS AND PARTICIPANTS We conducted a secondary analysis of a previously published randomized controlled trial of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the AUDIT-C scale. INTERVENTION OR EXPOSURE Patients were randomized into two groups, with the control group receiving two leaflets: one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. OUTCOMES MEASURE AND ANALYSIS Long-term assessment primary outcome was the proportion of at-risk alcohol use measured by AUDIT-C scale. The main effectiveness analysis at 18 weeks and 12 months' follow-up was conducted with multilevel logistic regression analyses. Missing values were imputed with the last observation carried forward. MAIN RESULTS Of 200 patients included in the study, 133 (66.5%) and 131 (65.5%) completed 18 weeks and 1-year follow-up respectively. Although the proportion of risky drinkers was substantially lower in the intervention group (38.5 vs. 57.4% at 4.5 months and 58.5 vs 68.2% at 1 year), these results did not reach statistical significance (OR = 2.15; CI, 0.87-5.33). CONCLUSIONS In this secondary analysis for mid- and long-term effects of a specialized SBIRT program, there was no significant difference in the reduction of risky drinkers at 18 weeks and 1 year. The small size of the studied sample and the low retention rate precluded any significant conclusion, although point estimates suggest a positive effect. Overall, SBIRT programs are an effective tool to reduce alcohol use at short time and to refer patients to specialized treatment; however, its effects seem to decay over time.
Collapse
Affiliation(s)
- Pol Bruguera
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Pablo Barrio
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Jakob Manthey
- Center for Clinical Epidemiology and Longitudinal Studies, Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Clara Oliveras
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laura Nuño
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laia Miquel
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Ana López-Lazcano
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Chrysanthi Blithikioti
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Elsa Caballeria
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Silvia Matrai
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Jürgen Rehm
- Center for Clinical Epidemiology and Longitudinal Studies, Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Dalla Lana School of Public Health, Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Eduard Vieta
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Centro de Investigación en Red de Salud mental (CIBERSAM), Madrid
| | - Antoni Gual
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Hospital Clínic
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona
- Grup de Recerca en Addiccions Clínic, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| |
Collapse
|
5
|
Ahn S, Mello M, Baird J, Strezsak V, Choo EK. Emergency Department Patients are Receptive to Prayer-Based Interventions to Reduce Alcohol Use. JOURNAL OF RELIGION AND HEALTH 2020; 59:1913-1924. [PMID: 30771141 DOI: 10.1007/s10943-019-00779-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Previous studies show that elements of spirituality, including prayer and religious services, may contribute to reductions in harmful alcohol use. The objective of this study was to assess the acceptability of prayer as a component of emergency department (ED) interventions for risky alcohol use. A 12-question multiple-choice questionnaire was developed, piloted, and refined by the study team. The questionnaire included questions about current beliefs and attitudes toward prayer and assessed interest in various means of delivering prayer or prayer support for reducing alcohol use. The questionnaire was administered to a consecutive sample of 111 patients recruited from the 12-month follow-up of a parent RCT study on reducing alcohol use among injured ED patients (ReDIAL). To qualify for the parent study, participants needed an ASSIST v3.0 alcohol score ≥ 11. 90 participants (81%) consented to answer questions about prayer. The participating sample was 38% female and 29% nonwhite; mean age was 36 years. Of these participants, 64% reported that they currently pray; of those, 88% reported praying daily or weekly; 79% agreed that prayer helps with coping in difficult times; 68% agreed that prayer could assist in achieving difficult goals; and 48% agreed that prayer helps reduce alcohol use. Interest in various means of utilizing prayer to reduce alcohol use was assessed in all participants (regardless of whether they currently prayed or not): 45% were interested in having others pray for them to reduce alcohol use; 40% were interested in receiving text reminders to pray; 42% were interested in receiving text messages with specific prayers to use; and 47% were interested in receiving text messages that someone was praying for them. 33.3% of the entire sample stated that they would attend services if provided information on spiritual or religious groups in the community. The incorporation of prayer in alcohol interventions was considered acceptable by a proportion of our sample of risky alcohol users, even those who do not currently use prayer as a resource in their lives. Given the promising data on ED patients' perceptions of the significance and acceptability of spiritual practices in reducing alcohol use, prayer may emerge as a useful adjunctive tool in future ED interventions for alcohol use disorders.
Collapse
Affiliation(s)
- Susie Ahn
- Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Mello
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Janette Baird
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Valerie Strezsak
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Esther K Choo
- Center for Policy & Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
6
|
Kim HS, Courtney DM, McCarthy DM, Cella D. Patient-reported Outcome Measures in Emergency Care Research: A Primer for Researchers, Peer Reviewers, and Readers. Acad Emerg Med 2020; 27:403-418. [PMID: 31945245 DOI: 10.1111/acem.13918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
Abstract
Patient-reported outcomes (PROs) are of increasing importance in clinical research because they capture patients' experience with well-being, illness, and their interactions with health care. Because PROs tend to focus on specific symptoms (e.g., pain, anxiety) or general assessments of patient functioning and quality of life that offer unique advantages compared to traditional clinical outcomes (e.g., mortality, emergency department revisits), emergency care researchers may benefit from incorporation of PRO measures into their research design as a primary or secondary outcome. Patients may also benefit from the ability of PROs to inform clinical practice and facilitate patient decision making, as PROs are obtained directly from the lived experience of other patients with similar conditions or health status. This review article introduces and defines key terminology relating to PROs, discusses reasons for utilizing PROs in clinical research, outlines basic psychometric and practical assessments that can be used to select a specific PRO measure, and highlights examples of commonly utilized PRO measures in emergency care research.
Collapse
Affiliation(s)
- Howard S. Kim
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - D. Mark Courtney
- Department of Emergency Medicine University of Texas Southwestern Medical School Dallas TX
| | - Danielle M. McCarthy
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - David Cella
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL
- Center for Patient‐Centered Outcomes Northwestern University Feinberg School of Medicine Chicago IL
| |
Collapse
|
7
|
Kahler CW, Surace A, Durst A, Pantalone DW, Mastroleo NR, Miguez MJ, Bueno D, Liu T, Monti PM, Mayer KH. Telehealth interventions to reduce alcohol use in men with HIV who have sex with men: Protocol for a factorial randomized controlled trial. Contemp Clin Trials Commun 2019; 16:100475. [PMID: 31701045 PMCID: PMC6831665 DOI: 10.1016/j.conctc.2019.100475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Heavy alcohol use is prevalent among men who have sex with men (MSM) living with HIV and is associated with reduced antiretroviral therapy adherence, reduced HIV viral suppression, and reduced survival. We recently found that compared to HIV treatment as usual, three sessions of in-person motivational interviewing (MI) substantially reduced drinking in MSM with HIV. In an effort to enhance the effectiveness and efficiency of this intervention, the present study will test whether MI is more effective than brief intervention when delivered by videoconferencing, whether interactive text messaging (ITM) can enhance the effects of alcohol intervention, and whether extended duration of intervention is more effective than brief duration. METHODS Using a 2 × 2 × 2 factorial design, we will randomly assign 224 heavy-drinking MSM with HIV to: MI or brief intervention (BI); ITM or no ITM; Standard or Extended intervention (EI). All participants will receive intervention immediately after baseline assessment via videoconferencing and at 1-month post baseline via telephone. Participants randomized to EI will receive additional intervention sessions at 3, 6, and 9 months. Participants randomized to ITM will receive daily interactive texts about alcohol use for 1 month, with those randomized to EI receiving weekly interactive texts through 9 months. Alcohol and HIV-related outcomes will be assessed at 6 and 12 months post baseline. CONCLUSION By testing the combinations of interventions that can most effectively reduce alcohol use among MSM with HIV, this study will set the stage for wider-scale implementation of an optimized intervention combination.
Collapse
Affiliation(s)
- Christopher W. Kahler
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Anthony Surace
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ayla Durst
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health Boston, MA, USA
- University of Massachusetts - Boston, Boston, MA, USA
| | - Nadine R. Mastroleo
- College of Community and Public Affairs, Binghamton University (SUNY), Binghamton, NY, USA
| | | | - Diego Bueno
- Florida International University, Miami, FL, USA
| | - Tao Liu
- Center for Statistical Sciences and Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Peter M. Monti
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health Boston, MA, USA
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Säfsten E, Forsell Y, Ramstedt M, Damström Thakker K, Galanti MR. A pragmatic randomised trial of two counselling models at the Swedish national alcohol helpline. BMC Psychiatry 2019; 19:213. [PMID: 31286906 PMCID: PMC6615184 DOI: 10.1186/s12888-019-2199-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 06/25/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Alcohol telephone helplines targeting alcohol consumers in the general population can extend the reach of brief interventions while preserving in-person counselling. So far, studies of client outcomes in the setting of alcohol helplines are scarce. This study aims to compare the 6-months alcohol-related outcomes of two counselling models delivered at the Swedish National Alcohol Helpline. METHODS A pragmatic randomised trial was set up at the Swedish National Alcohol Helpline. First-time callers with current hazardous or harmful alcohol use who contacted the helpline, from May 2015 to December 2017, were invited to participate. Clients were allocated with 1:1 ratio to two groups: (1) brief, structured intervention (n = 128), including self-help material and one counsellor-initiated call, and (2) usual care (n = 133), i.e. multiple-session counselling using Motivational Interviewing (MI). The primary outcome was a downward change in AUDIT risk-zone between baseline and 6-months follow-up. The analysis followed an intention-to-treat approach. RESULTS Recruitment ended in December 2017. At 6-months follow-up, 70% of the enrolled participants had data on the outcome. In the brief, structured intervention (n = 107) 68% changed to a lower risk-level, compared to 61% in the usual care group (n = 117), yielding a risk ratio (RR) of 1.12 (95% CI 0.93 to 1.37) and risk difference of 0.08 (95% CI -0.05 to 0.20). The total AUDIT score and the scores from the AUDIT consumption questions (AUDIT-C) did not reveal any between-group differences in the mean change at follow-up. CONCLUSIONS The counselling at the Swedish National Alcohol Helpline was followed by a significant decrease in alcohol use among clients, without clear superiority for either counselling model. TRIAL REGISTRATION This trial was retrospectively registered with ISRCNT.com (ID: ISRCTN13160878 ) 18/01/2016.
Collapse
Affiliation(s)
- Eleonor Säfsten
- Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Yvonne Forsell
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden ,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| | - Mats Ramstedt
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden ,The Swedish Council for Information on Alcohol and Other Drugs (CAN), 107 25 Stockholm, Sweden
| | - Kerstin Damström Thakker
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| | - Maria Rosaria Galanti
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden ,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| |
Collapse
|
9
|
Biroscak BJ, Pantalon MV, Dziura JD, Hersey DP, Vaca FE. Use of non-face-to-face modalities for emergency department screening, brief intervention, and referral to treatment (ED-SBIRT) for high-risk alcohol use: A scoping review. Subst Abus 2019; 40:20-32. [PMID: 30829126 PMCID: PMC6579646 DOI: 10.1080/08897077.2018.1550465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this review was to examine and chart the "scope" of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non-face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14 years (2003-2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: "screening" (e.g., computer tablet screening), "brief intervention" (e.g., text message-based brief interventions), and "referral to treatment" (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies-including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.
Collapse
Affiliation(s)
- Brian J Biroscak
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Michael V Pantalon
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - James D Dziura
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Denise P Hersey
- b Department of Clinical Information Services, Cushing/Whitney Medical Library , Yale University , New Haven , Connecticut , USA
| | - Federico E Vaca
- a Department of Emergency Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| |
Collapse
|
10
|
Binswanger IA, Carroll NM, Ahmedani BK, Campbell CI, Haller IV, Hechter RC, McNeely J, Yarborough BJH, Kline-Simon AH, Satre DD, Weisner C, Lapham GT. The association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement for alcohol and other drug use disorders. Subst Abus 2019; 40:292-301. [PMID: 30676892 DOI: 10.1080/08897077.2018.1545726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.Methods: We used electronic health record and insurance claims data from 7 US health care systems to identify patients with AOD use disorders between October 1, 2014, and August 15, 2015 (N = 86,565). Among patients identified with AOD use disorders in outpatient and emergency department (ED) settings, we examined how Charlson/Deyo comorbidity index scores and medical complications of AOD use were associated with treatment initiation. Among those who initiated treatment in inpatient and outpatient/ED settings, we also examined how comorbidity and AOD use-related medical complications were associated with treatment engagement. Analyses were conducted using generalized estimating equation logistic regression modeling.Results: Among patients identified as having an AOD diagnosis in outpatient and ED settings (n = 69,965), Charlson/Deyo comorbidity index scores of 2 or more were independently associated with reduced likelihood of initiation (risk ratio [RR] = 0.80, 95% confidence interval [CI] = 0.74, 0.86; reference score = 0), whereas prior-year diagnoses of cirrhosis (RR = 1.25, 95% CI = 1.12, 1.35) and pancreatic disease (RR = 1.34, 95% CI = 1.15, 1.56) were associated with greater likelihood of initiation. Among those who were identified in outpatient/ED settings and initiated, higher comorbidity scores were associated with lower likelihood of engagement (score 1: RR = 0.85, 95% CI = 0.76, 0.94; score 2+: RR = 0.61, 95% CI = 0.53, 0.71).Conclusion: Medical comorbidity was associated with lower likelihood of initiating or engaging in AOD treatment, but cirrhosis and pancreatic disease were associated with greater likelihood of initiation. Interventions to improve AOD treatment initiation and engagement for patients with comorbidities are needed, such as integrating medical and AOD treatment.
Collapse
Affiliation(s)
- Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.,Colorado Permanente Medical Group, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | | | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia, Essentia Health, Duluth, Minnesota, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | | | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| |
Collapse
|
11
|
Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
Collapse
Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
| | | |
Collapse
|
12
|
Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2017; 70:714-723.e13. [DOI: 10.1016/j.annemergmed.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/03/2023]
|
13
|
Barata IA, Shandro JR, Montgomery M, Polansky R, Sachs CJ, Duber HC, Weaver LM, Heins A, Owen HS, Josephson EB, Macias-Konstantopoulos W. Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review. West J Emerg Med 2017; 18:1143-1152. [PMID: 29085549 PMCID: PMC5654886 DOI: 10.5811/westjem.2017.7.34373] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Alcohol use disorders (AUD) place a significant burden on individuals and society. The emergency department (ED) offers a unique opportunity to address AUD with brief screening tools and early intervention. We undertook a systematic review of the effectiveness of ED brief interventions for patients identified through screening who are at risk for AUD, and the effectiveness of these interventions at reducing alcohol intake and preventing alcohol-related injuries. METHODS We conducted systematic electronic database searches to include randomized controlled trials of AUD screening, brief intervention, referral, and treatment (SBIRT), from January 1966 to April 2016. Two authors graded and abstracted data from each included paper. RESULTS We found 35 articles that had direct relevance to the ED with enrolled patients ranging from 12 to 70 years of age. Multiple alcohol screening tools were used to identify patients at risk for AUD. Brief intervention (BI) and brief motivational intervention (BMI) strategies were compared to a control intervention or usual care. Thirteen studies enrolling a total of 5,261 participants reported significant differences between control and intervention groups in their main alcohol-outcome criteria of number of drink days and number of units per drink day. Sixteen studies showed a reduction of alcohol consumption in both the control and intervention groups; of those, seven studies did not identify a significant intervention effect for the main outcome criteria, but nine observed some significant differences between BI and control conditions for specific subgroups (i.e., adolescents and adolescents with prior history of drinking and driving; women 22 years old or younger; low or moderate drinkers); or secondary outcome criteria (e.g. reduction in driving while intoxicated). CONCLUSION Moderate-quality evidence of targeted use of BI/BMI in the ED showed a small reduction in alcohol use in low or moderate drinkers, a reduction in the negative consequences of use (such as injury), and a decline in ED repeat visits for adults and children 12 years of age and older. BI delivered in the ED appears to have a short-term effect in reducing at-risk drinking.
Collapse
Affiliation(s)
- Isabel A. Barata
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jamie R. Shandro
- Harborview Medical Center, University of Washington Medical Center, Department of Emergency Medicine, Seattle, Washington
| | | | - Robin Polansky
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Carolyn J. Sachs
- UCLA David Geffen School of Medicine, Emergency Medicine Center, Los Angeles, California
| | - Herbert C. Duber
- Harborview Medical Center, University of Washington Medical Center, Department of Emergency Medicine, Seattle, Washington
| | - Lindsay M. Weaver
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Alan Heins
- Cullman Regional Medical Center, Department of Emergency Medicine, Cullman, Alabama
| | - Heather S. Owen
- Parkland Memorial Hospital, Department of Emergency Medicine, Dallas, Texas
| | - Elaine B. Josephson
- Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx, New York
| | | |
Collapse
|
14
|
Baird J, Yang E, Strezsak V, Mello MJ. Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients. TRAFFIC INJURY PREVENTION 2017; 18:463-469. [PMID: 27922270 PMCID: PMC6168940 DOI: 10.1080/15389588.2016.1265953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels. METHODS This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving. RESULTS Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment. CONCLUSIONS This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.
Collapse
Affiliation(s)
- Janette Baird
- Injury Prevention Center at Rhode Island Hospital
- Department of Emergency Medicine, Alpert School of Medicine at Brown University
| | - Eunice Yang
- Injury Prevention Center at Rhode Island Hospital
| | - Valerie Strezsak
- Injury Prevention Center at Rhode Island Hospital
- Department of Epidemiology, Brown University School of Public Health; Department of Health Service, Practice and Policy, Brown University School of Public Health
| | - Michael J Mello
- Injury Prevention Center at Rhode Island Hospital
- Department of Emergency Medicine, Alpert School of Medicine at Brown University
| |
Collapse
|
15
|
Säfsten E, Forsell Y, Ramstedt M, Galanti MR. Comparing counselling models for the hazardous use of alcohol at the Swedish National Alcohol Helpline: study protocol for a randomised controlled trial. Trials 2017; 18:257. [PMID: 28587621 PMCID: PMC5461736 DOI: 10.1186/s13063-017-2005-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hazardous and harmful consumption of alcohol is a leading cause of preventable disease and premature deaths. Modifying the amount and pattern of risky alcohol consumption conveys substantial benefits to individuals and to society at large. Telephone helplines provide a feasible alternative to face-to-face counselling in order to increase the reach of brief interventions aiming at modifying the hazardous and harmful use of alcohol. However, there is a lack of studies on the implementation and evaluation of population-based telephone services for the prevention and treatment of alcohol misuse. METHODS/DESIGN A randomised controlled trial was designed to compare a brief, structured intervention to usual care within the Swedish National Alcohol Helpline (SAH), concerning their effectiveness on decreasing the hazardous use of alcohol. Between May 2015 and December 2017, about 300 callers are to be individually randomised with a 1:1 ratio to a brief, structured intervention (n = 150) or to usual care (n = 150). The brief, structured intervention consists of the delivery of a self-help booklet followed by one proactive call from SAH counsellors to monitor and give feedback about the client's progression. Callers assigned to usual care receive telephone counselling according to existing practice, i.e., motivational interviewing in a tailored and client-driven combination of proactive and reactive calls. The primary outcome is defined as a change from a higher to a lower AUDIT risk-level category between baseline and follow-up. General linear modeling will be used to calculate risk ratios of the outcome events. The primary analysis will follow an intention-to-treat (ITT) approach. DISCUSSION The trial is designed to evaluate the effectiveness in decreasing the hazardous and harmful consumption of alcohol of a brief, structured intervention compared to usual care when delivered at the SAH. The results of the study will be used locally to improve the effectiveness of the service provided at the SAH. Additionally, they will expand the evidence base about optimal counselling models in population-based telephone services for alcohol misuse prevention and treatment. TRIAL REGISTRATION ISRCNT.com, ID: ISRCTN13160878 . Retrospectively registered on 18 January 2016.
Collapse
Affiliation(s)
- Eleonor Säfsten
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, 113 65 Stockholm, Sweden
| | - Mats Ramstedt
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), 107 25 Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, 113 65 Stockholm, Sweden
| |
Collapse
|
16
|
Strezsak V, Baird J, Lee CS, Mello MJ. Cross-Sectional Study of Risky Substance Use by Injured Emergency Department Patients. West J Emerg Med 2017; 18:345-348. [PMID: 28435483 PMCID: PMC5391882 DOI: 10.5811/westjem.2017.1.32180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Survey data regarding the prevalence of risky substance use in the emergency department (ED) is not consistent. The objective of this study was to identify the prevalence of risky substance use among injured ED patients based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.0). A secondary objective was to report on the feasibility of administering the ASSIST to this population, based on the time to conduct screening. METHODS This cross-sectional study used screening data from a randomized controlled trial. Injured ED patients completed the ASSIST on a tablet computer, and an ASSIST score was computed that indicated the need for a brief or intensive treatment intervention (risky use) for alcohol and other substances. For a subsample, data on time to complete each step of screening was recorded. RESULTS Between July 2010 and March 2013, 5,695 patients completed the ASSIST. Most (92%) reported lifetime use of at least one substance and 51% reported current risky use of at least one substance. Mean time to complete the ASSIST was 5.4 minutes and screening was considered feasible even when paused for clinical care to proceed. CONCLUSION Estimates of risky substance use based on the ASSIST in our large sample of injured ED patients were higher than previously reported in other studies of ED patients, possibly due to the current focus on an injured population. In addition, it was feasible to administer the ASSIST to patients in the course of their clinical care.
Collapse
Affiliation(s)
- Valerie Strezsak
- Brown University, Department of Epidemiology, Providence, Rhode Island.,Injury Prevention Center at Rhode Island Hospital, Providence, Rhode Island
| | - Janette Baird
- Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Injury Prevention Center at Rhode Island Hospital, Providence, Rhode Island
| | - Christina S Lee
- Northeastern University, Department of Applied Psychology, Boston, Massachusetts
| | - Michael J Mello
- Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Injury Prevention Center at Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
17
|
Nicks BA, Shah MN, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Malveau SE, Nishijima DK, Stiffler KA, Storrow AB, Wilber ST, Yagapen AN, Sun BC. Minimizing Attrition for Multisite Emergency Care Research. Acad Emerg Med 2017; 24:458-466. [PMID: 27859997 DOI: 10.1111/acem.13135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
Loss to follow-up of enrolled patients (a.k.a. attrition) is a major threat to study validity and power. Minimizing attrition can be challenging even under ideal research conditions, including the presence of adequate funding, experienced study personnel, and a refined research infrastructure. Emergency care research is shifting toward enrollment through multisite networks, but there have been limited descriptions of approaches to minimize attrition for these multicenter emergency care studies. This concept paper describes a stepwise approach to minimize attrition, using a case example of a multisite emergency department prospective cohort of over 3,000 patients that has achieved a 30-day direct phone follow-up attrition rate of <3%. The seven areas of approach to minimize attrition in this study focused on patient selection, baseline contact data collection, patient incentives, patient tracking, central phone banks, local enrollment site assistance, and continuous performance monitoring. Appropriate study design, including consideration of these methods to reduce attrition, will be time well spent and may improve study validity.
Collapse
Affiliation(s)
- Bret A. Nicks
- Department of Emergency Medicine; Wake Forest School of Medicine; Winston-Salem NC
| | - Manish N. Shah
- Department of Emergency Medicine; University of Wisconsin-Madison; Madison WI
| | - David H. Adler
- Department of Emergency Medicine; University of Rochester; Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine; William Beaumont Hospital-Troy; Troy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - Carol L. Clark
- Department of Emergency Medicine; William Beaumont Hospital-Royal Oak; Royal Oak MI
| | - Deborah B. Diercks
- Department of Emergency Medicine; University of Texas-Southwestern; Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine; Thomas Jefferson University Hospital; Philadelphia PA
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
| | - Daniel K. Nishijima
- Department of Emergency Medicine; UC Davis School of Medicine; Sacramento CA
| | | | - Alan B. Storrow
- Department of Emergency Medicine; Vanderbilt University Medical Center; Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine; Summa Health System; Akron OH
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
| |
Collapse
|