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Chan PSF, Fang Y, Wong MCS, Huang J, Wang Z, Yeoh EK. Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review. Implement Sci 2021; 16:99. [PMID: 34801041 PMCID: PMC8605518 DOI: 10.1186/s13012-021-01170-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). METHODS We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. RESULTS A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. CONCLUSIONS Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. TRIAL REGISTRATION This systematic review was registered in PROSPERO ( CRD42021258833 ).
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Affiliation(s)
- Paul Shing-Fong Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, China
| | - Martin Chi-Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Thørrisen MM, Bonsaksen T, Skogen JC, Skarpaas LS, Sevic A, van Mechelen W, Aas RW. Willingness to Participate in Alcohol Prevention Interventions Targeting Risky Drinking Employees. The WIRUS Project. Front Public Health 2021; 9:692605. [PMID: 34249850 PMCID: PMC8267363 DOI: 10.3389/fpubh.2021.692605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/31/2021] [Indexed: 01/10/2023] Open
Abstract
Background: The extent to which eligible individuals in a target population are willing to participate in interventions is important when evaluating the efficacy of public health interventions. Objectives: As part of a process evaluation of an ongoing randomized controlled trial, this study aimed to identify the proportion of risky drinkers who were willing to participate in an alcohol prevention intervention in an occupational health setting, and correlates for such willingness. Methods: Risky drinking employees from 22 companies in Norway were identified through an alcohol screening survey. Risky drinkers' (N = 779) willingness to complete a health examination and to be randomized into an alcohol prevention intervention (digital or face-to-face intervention, or control) was recorded by personnel from occupational health services. The proportion of employees who were willing to participate was assessed on 31 potential correlates (sociodemographic, alcohol-related, work-related, and lifestyle/daily activity). Adjusted (multiple logistic regression) analyses were utilized to explore associations between potential correlates and willingness to participate. Results: Altogether, 38.1% of employees were willing to participate in prevention interventions. In the adjusted analysis, only 5 out of 31 potential correlates were significantly associated with willingness to participate. Managers were more than twice as willing to participate than workers (OR = 2.17, p < 0.01). Willing employees had less workplace decision latitude (perceived control over workplace decisions and less possibility of utilizing personal skills in the job) (OR = 0.62, p < 0.05), and were more overcommitted with exorbitant work ambition and need for approval (OR = 1.49, p < 0.05). Willing employees had to some extent less alcohol-related impaired work performance (presenteeism, OR = 0.78, p < 0.05), and they spent less time on care activities (OR = 0.84, p < 0.05). Conclusions: Reaching four out of ten with risky drinking habits for prevention interventions strengthens the rationale for targeting this public health problem in occupational health care settings. In particular, this study suggests the importance of ensuring secure commitment among workers, who were less willing til participate than managers. Nevertheless, tailoring recruitment and implementation strategies based on easily identifiable correlates may be onerous.
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Affiliation(s)
- Mikkel Magnus Thørrisen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tore Bonsaksen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Faculty of Health Sciences, VID Specialized University, Sandnes, Norway
| | - Jens Christoffer Skogen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Sandnes, Norway.,Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Lisebet Skeie Skarpaas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Aleksandra Sevic
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location VUmc), Amsterdam, Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia.,Division of Exercise and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Fankhaenel T, Mueller AM, Frese T. General Practice Patients' Readiness to be Treated With Brief Intervention to Reduce Alcohol Consumption: A Cross-Sectional Study With Between-Subject Design. Alcohol Alcohol 2021; 56:291-298. [PMID: 33089327 DOI: 10.1093/alcalc/agaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/07/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To treat excessive alcohol consumption, general practices (GPs) are recommended to use non-directive implementation strategies. Directive implementation, however, may be perceived by general practice patients as something positive because of possibly indicating higher GP engagement and a more consistent treatment. In our study, we aimed to assess the readiness of patients to be treated with BI in the hypothetical event of excessive alcohol consumption either by a GP using non-directive recommendations according to WHO or by a GP using directive instructions. Additionally, we assessed the patients' dispositional readiness to disclose alcohol-associated personal information, termed alcohol consumption self-disclosure, in order to analyze its influence on their readiness to be treated with brief intervention (BI). METHODS When consulting their GP, a convenience sample of general practice patients was asked by questionnaire. By means of a between-subject design, they were asked for the readiness to be treated either with non-directive BI or with directive BI. Repeated-measure ANCOVA was used to analyze the main- and interaction effects. RESULTS A sample of 442 general practice patients preferred the non-directive BI, F(1, 423) = 5.56, P < 0.05. We found moreover a two-way interaction between implementation and alcohol consumption self-disclosure, F(1, 423) = 18.89, P < 0.001, showing that only patients with low self-disclosure preferred the non-directive BI, t(428) = 3.99, P < 0.001. CONCLUSIONS Future research should investigate the reasons for the patients' preference for the non-directive BI and may develop strategies to overcome the possibly low readiness of general practice patients to be treated with BI.
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Affiliation(s)
- Thomas Fankhaenel
- Institute for General Practice and Family Medicine, Medical Faculty, University of Halle-Wittenberg, Magdeburger Str. 8, Halle/Saale 06112, Germany
| | - Anna-Maria Mueller
- Institute for General Practice and Family Medicine, Medical Faculty, University of Halle-Wittenberg, Magdeburger Str. 8, Halle/Saale 06112, Germany
| | - Thomas Frese
- Institute for General Practice and Family Medicine, Medical Faculty, University of Halle-Wittenberg, Magdeburger Str. 8, Halle/Saale 06112, Germany
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4
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Rosário F, Santos MI, Angus K, Pas L, Ribeiro C, Fitzgerald N. Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework. Implement Sci 2021; 16:6. [PMID: 33413487 PMCID: PMC7791720 DOI: 10.1186/s13012-020-01073-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults. METHODS A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). RESULTS Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training). CONCLUSIONS This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016052681.
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Affiliation(s)
- Frederico Rosário
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. .,Agrupamento de Centros de Saúde Dão Lafões, Av. António José de Almeida - Edíficio MAS, 3514-511, Viseu, Portugal.
| | - Maria Inês Santos
- Hospital Casa de Saúde São Mateus SA, Rua 5 de Outubro 183, 3500-093, Viseu, Portugal
| | - Kathryn Angus
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 33 blok j - box 7001, 3000, Leuven, Belgium
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Niamh Fitzgerald
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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Fankhaenel T, Schulz K, Petersen LE, Klement A, Frese T. Financial reimbursement - irrelevant for GPs' readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study. BMC FAMILY PRACTICE 2020; 21:170. [PMID: 32814561 PMCID: PMC7439686 DOI: 10.1186/s12875-020-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/22/2020] [Indexed: 11/14/2022]
Abstract
Background General Practitioners’ (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs’ readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement. Methods A convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs’ implementation readiness a 4-item 6-point Likert scale was developed and pretested. Results One hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p > .001 (main effect). We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns. Conclusions Further research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.
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Affiliation(s)
- Thomas Fankhaenel
- University of Halle-Wittenberg, Halle, Germany. .,SRH University of Applied Health Sciences, Gera, Germany.
| | - Katrin Schulz
- SRH University of Applied Health Sciences, Gera, Germany
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 PMCID: PMC8372233 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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7
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Kim J, Hendershot CS. A review of performance indicators of single-item alcohol screening questions in clinical and population settings. J Subst Abuse Treat 2020; 111:73-85. [DOI: 10.1016/j.jsat.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
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8
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Lubman DI, Grigg J, Manning V, Hall K, Volpe I, Dias S, Baker A, K Staiger P, Reynolds J, Harris A, Tyler J, Best D. A structured telephone-delivered intervention to reduce problem alcohol use (Ready2Change): study protocol for a parallel group randomised controlled trial. Trials 2019; 20:515. [PMID: 31426835 PMCID: PMC6701125 DOI: 10.1186/s13063-019-3462-9] [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] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current population surveys suggest around 20% of Australians meet diagnostic criteria for an alcohol use disorder. However, only a minority seek professional help due to individual and structural barriers, such as low health literacy, stigma, geography, service operating hours and wait lists. Telephone-delivered interventions are readily accessible and ideally placed to overcome these barriers. We will conduct a randomised controlled trial (RCT) to examine the efficacy of a standalone, structured telephone-delivered intervention to reduce alcohol consumption, problem severity and related psychological distress among individuals with problem alcohol use. Methods/design This is a single site, parallel group, two-arm superiority RCT. We will recruit 344 participants from across Australia with problem alcohol use. After completing a baseline assessment, participants will be randomly allocated to receive either the Ready2Change (R2C) intervention (n = 172, four to six sessions of structured telephone-delivered intervention, R2C self-help resource, guidelines for alcohol consumption and stress management pamphlets) or the control condition (n = 172, four phone check-ins < 5 min, guidelines for alcohol consumption and stress management pamphlets). Telephone follow-up assessments will occur at 4–6 weeks, 3 months, 6 months and 12 months post-baseline. The primary outcome is the Alcohol Use Disorders Identification Test (AUDIT) score administered at 3 months post-baseline. Secondary outcomes include change in AUDIT score (6 and 12 months post-baseline), change in number of past-month heavy drinking days, psychological distress, health and wellbeing, quality of life, client treatment evaluation and cost effectiveness. Discussion This study will be one of the first RCTs conducted internationally to examine the impact of a standalone, structured telephone-delivered intervention to address problem alcohol use and associated psychological morbidity. The proposed intervention is expected to contribute to the health and wellbeing of individuals who are otherwise unlikely to seek treatment through mainstream service models, to reduce the burden on specialist services and primary care providers and to provide an accessible and proportionate response, with resulting cost savings for the health system and broader community. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000828224. Pre-registered on 16 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3462-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, Australia. .,Turning Point, Eastern Health, Richmond, Australia.
| | - Jasmin Grigg
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | | | | | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Clayton, Australia
| | | | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
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Abidi L, Oenema A, Verhaak P, Tan FES, van de Mheen D. The introduction of the practice nurse mental health in general practices in the Netherlands: effects on number of diagnoses of chronic and acute alcohol abuse. BMC FAMILY PRACTICE 2019; 20:48. [PMID: 30940080 PMCID: PMC6444815 DOI: 10.1186/s12875-019-0938-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse. METHODS The Netherlands Institute for Health Services Research (NIVEL) retrieved data of a representative sample of general practices (n = 155) for this study. Data were aligned at the starting point of the implementation of the PN-MH to compare the practices on our outcome measures after implementation of the PN-MH. Multilevel regression analyses were conducted to investigate differences in average number of chronic and acute alcohol abuse diagnoses between practices with a practice nurse mental health and control practices (without a practice nurse mental health and without a primary care psychologists). RESULTS A significant decrease over time of chronic alcohol abuse diagnoses was observed (ß = -.52, p < 0.05) as well as a significant decrease over time of acute alcohol abuse diagnoses (ß = -.06, p < 0.05). After adjustment for multiple comparisons, no significant differences were found between practices that implemented a practice nurse mental health or only have a primary care psychologist and control practices. Practices that implemented a practice nurse mental health and have a primary care psychologist, had a higher mean of chronic and acute alcohol abuse diagnoses than control practices during all periods, but the differences between these groups were not statistically significant. CONCLUSIONS Based on the results of this study it seems that the introduction of practice nurses mental health in general practices is not associated with increased diagnoses of chronic or acute alcohol abuse. Potential explanations are barriers experienced by practice nurses to addressing alcohol use with patients and prioritization of other mental health issues over alcohol abuse. In order to improve the management of alcohol abuse by practice nurses, more research is needed on how practice nurses can be involved in diagnosing and treatment of patients with alcohol abuse.
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Affiliation(s)
- L Abidi
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - A Oenema
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands
| | - P Verhaak
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
- Department of Family Practice, Groningen University, University Medical Center Groningen, Groningen, the Netherlands
| | - F E S Tan
- Department of Statistics and Methodology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - D van de Mheen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands
- Tranzo, Tilburg University, School of Social and Behavioral Sciences, Tilburg, the Netherlands
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Staton CA, Vissoci JRN, Wojcik R, Hirshon JM, Mvungi M, Mmbaga BT, Swahn M. Perceived barriers by health care providers for screening and management of excessive alcohol use in an emergency department of a low-income country. Alcohol 2018; 71:65-73. [PMID: 30055405 DOI: 10.1016/j.alcohol.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/17/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
Annually, alcohol causes 3.3 million deaths; countless more alcohol-related injury patients are treated in emergency departments (EDs) worldwide. Studies show that alcohol-related injury patients reduce their at-risk alcohol-use behavior with a brief negotiational interview (BNI) in the ED. This project aims to identify potential perceived barriers to implementing a BNI in Tanzania. A knowledge, attitude, and practice questionnaire was piloted and administered to all emergency department health care practitioners, including physicians, advanced medical officers, and nurses. The questionnaire included the Perceived Alcohol Stigma (PAS) Scale. The survey was self-administered in English, the language of health care instruction, with a Swahili translation available if preferred. Data were analyzed with relative and absolute frequencies and Spearman's correlation. Thirty-four (100%) health care practitioners completed the survey. Our results found positive attitudes toward addressing alcohol misuse (88%), but very poor knowledge of recommended alcohol-use limits (24%). Participants were willing to discuss alcohol use (88%) and to screen (71%) for alcohol-use disorders. Most health care practitioners report significant stigma against those with alcohol-use disorders (39% discrimination, 53% devaluation, 71% either). Counseling patients about high-risk alcohol use was directly and positively associated with at-risk alcohol and counseling education and believing it was common to ask patients about tobacco and alcohol use; it was negatively associated with believing it was 'not my role' or that knowing about alcohol use 'won't make a difference'. Stigma was negatively and indirectly associated with counseling patients. In conclusion, in an ED in Tanzania, health care practitioners have positive attitudes toward addressing at-risk alcohol use, and endorsed having training in alcohol misuse in school. Unfortunately, participants did not demonstrate knowledge of recommended alcohol limit guidelines. Similarly, among practitioners, there is a significant discrimination and devaluation stigma against those who misuse alcohol. These factors must be addressed prior to a successful implementation of an alcohol harm reduction intervention.
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Affiliation(s)
- Catherine A Staton
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States.
| | - Joao Ricardo Nickenig Vissoci
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Rachel Wojcik
- University of Colorado School of Medicine, Denver, CO, United States
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Monica Swahn
- School of Public Health, Georgia State University, Atlanta, Georgia, United States
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Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Kaner E, McGovern R, Newbury-Birch D, Patton R, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C. Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches. Alcohol Alcohol 2018; 52:312-317. [PMID: 28371897 DOI: 10.1093/alcalc/agx017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/12/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. Methods The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. Results A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. Conclusions While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact. Trial registration Current Controlled Trials ISRCTN06145674.
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Affiliation(s)
- Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury CT2 7NZ, Kent, UK
| | - Veronica Dale
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK
| | - Eilish Gilvarry
- Plummer Court - Northumberland Tyne and Wear NHS Foundation Trust, Newcastle NE1 6UR, UK
| | - Christine Godfrey
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Katherine Perryman
- Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.,Humber NHS Foundation Trust, Willerby HU10 6ED, UK
| | - Jonathan Shepherd
- Crime and Security Research Group, Cardiff University, Cardiff CF10 3DB, Wales, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK
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12
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Taylor G, McMahon C, Reeves L, Hickman M. 'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation. J Public Health (Oxf) 2018; 40:381-388. [PMID: 28977388 PMCID: PMC6053838 DOI: 10.1093/pubmed/fdx090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/18/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs' perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
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Affiliation(s)
- J Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - F Fox
- University Hospital Bristol, NHS Foundation Trust, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Kaner
- Institute of Health & Society, University of Newcastle, Newcastle upon Tyne, UK
| | - G Taylor
- Department for Health, University of Bath, Bath, UK
| | - C McMahon
- B&NES Council Public Health, Bath, UK
| | | | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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13
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O’Donnell A, Abidi L, Brown J, Karlsson N, Nilsen P, Roback K, Skagerström J, Thomas K. Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England. BMC Public Health 2018; 18:391. [PMID: 29562901 PMCID: PMC5863360 DOI: 10.1186/s12889-018-5275-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite robust evidence for their effectiveness, it has proven difficult to translate alcohol prevention activities into routine health care practice. Previous research has identified numerous provider-level barriers affecting implementation, but these have been less extensively investigated in the wider population. We sought to: (1) investigate patients' beliefs and attitudes to being asked about alcohol consumption in health care; and (2) identify the characteristics of those who are supportive of addressing alcohol consumption in health care. METHODS Cross-sectional household interviews conducted as part of the national Alcohol Toolkit Study in England between March and April 2017. Data were collected on age, gender, social grade, drinking category, and beliefs and attitudes to being asked about alcohol in routine health care. Unadjusted and multivariate-adjusted logistic regression models were performed to investigate associations between socio-demographic characteristics and drinking category with being "pro-routine" (i.e. 'agree completely' that alcohol consumption should be routinely addressed in health care) or "pro-personal" (i.e. 'agree completely' that alcohol is a personal matter and not something health care providers should ask about). RESULTS Data were collected on 3499 participants, of whom 50% were "pro-routine" and 10% were "pro-personal". Those in social grade C1, C2, D and E were significantly less likely than those in AB of being "pro-routine". Women were less likely than men to be "pro-personal", and those aged 35-44 or 65 years plus more likely to be "pro-personal" compared with participants aged 16-24. Respondents aged 65 plus were twice as likely as those aged 16-24 to agree completely that alcohol consumption is a personal matter and not something health care providers should ask about (OR 2.00, 95% CI 1.34-2.99). CONCLUSIONS Most adults in England agree that health care providers should routinely ask about patients' alcohol consumption. However, older adults and those in lower socio-economic groups are less supportive. Drinking status appears to have limited impact on whether people believe that alcohol is a personal matter and not something health care providers should ask about. REGISTRATION Open Science Framework ( https://osf.io/xn2st/ ).
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Affiliation(s)
- Amy O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Limburg Netherlands
| | - Jamie Brown
- Research Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine Karlsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Kerstin Roback
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Janna Skagerström
- Research and Development Unit, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
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14
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Evers E, Hahn S, Metzenthin P. [Impact of an e-learning program regarding patients' harmful alcohol consumption on the knowledge, attitudes and perceived competencies of nurses from an acute care hospital: a pretest-posttest-study]. Pflege 2018; 31:213-222. [PMID: 29361891 DOI: 10.1024/1012-5302/a000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Impact of an e-learning program regarding patients' harmful alcohol consumption on the knowledge, attitudes and perceived competencies of nurses from an acute care hospital: a pretest-posttest-study Abstract. BACKGROUND Harmful alcohol consumption is associated with approximately 1600 deaths in Switzerland annually, and is the third-largest risk factor for various diseases worldwide. It has been shown that through early identification of problematic drinking behaviours along with preventive intervention, alcohol-related illnesses and mortality can be reduced. Therefore, nurses play a crucial role for patients with alcohol problems. However, the most common reasons for nurses not providing preventive intervention are a lack of knowledge, personal attitudes and uncertainty. Learning programs hold the potential for influencing these factors. AIM The aim of this study was to assess the impact of an e-learning program regarding patients' harmful alcohol consumption on the knowledge, attitudes and perceived competencies of nurses in an acute care hospital. METHOD A pretest-posttest-study was conducted with 33 registered nurses prior to and upon completion of the e-learning program. Data was collected from December 2013 to March 2014 using a literature-based questionnaire. RESULTS It was shown that knowledge and perceived competencies significantly improved from pre-test to post-test. No significant differences were measured with regard to the attitudes. CONCLUSIONS The results suggest that the alcohol e-learning program could be used to enhance nurses' knowledge and perceived competencies, both of which are related to the reduction of uncertainty and improvement of confidence. To foster non-judgemental attitudes towards affected people, classroom courses are recommended in addition to the e-learning program and the implementation of directives.
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Affiliation(s)
| | - Sabine Hahn
- 2 Fachbereich Gesundheit, Berner Fachhochschule, Bern
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15
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Bachhuber MA, O'Grady MA, Chung H, Neighbors CJ, DeLuca J, D'Aloia EM, Diaz A, Cunningham CO. Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center. Addict Sci Clin Pract 2017; 12:33. [PMID: 29212532 PMCID: PMC5719726 DOI: 10.1186/s13722-017-0100-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background Screening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it. Methods We implemented a model of nursing staff-delivered SBI for unhealthy drinking for adult patients receiving primary care at an academically-affiliated Federally Qualified Health Center in the Bronx, NY. Our model consisted of nursing staff screening all patients with the alcohol use disorders identification test consumption questions (AUDIT-C) and, if screening positive, providing BI or referral to specialty services. We developed a clinical decision support tool integrated into the electronic health record to guide nursing staff and record SBI provision. To evaluate this model, we determined overall SBI delivery to patients and factors associated with receiving SBI. Results Between October 2013 and September 2014, 9119 unique adult patients made 24,285 visits. Patients were majority women (67.5%) and Hispanic/Latino (54.5%). Overall, 46.2% were screened, with 19.0–35.8% of eligible patients screened in each month. Increasing age (OR: 0.82 [95% CI 0.80–0.85] for a 10-year increase), female sex (OR: 0.83 [95% CI 0.77–0.91]), and chronic conditions like hypertension (OR: 0.62 [95% CI 0.56–0.70]) and diabetes (OR: 0.66 [95% CI 0.58–0.75]), among others, were associated with a lower odds of being screened. Of all patients screened, 225 (5.3%) screened positive and of those patients, 122 (54.2%) received a BI. Patients with higher AUDIT-C scores were more likely to receive a BI (OR: 1.24 [95% CI 1.04–1.47] for a 1-point increase) and non-English speaking patients were less likely to receive a BI than those who spoke English (OR: 0.42 [95% CI 0.18–0.97]). Conclusions Our model of SBI resulted in screening of nearly half of all eligible patients and BI provision to over half of those screening positive. Future efforts to improve SBI delivery should focus on groups such as older adults, women, and those with chronic medical conditions.
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Affiliation(s)
- Marcus A Bachhuber
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA.
| | - Megan A O'Grady
- Department of Health and Treatment Research and Analysis, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, 19th Floor, New York, NY, 10017, USA
| | - Henry Chung
- Montefiore Care Management, Montefiore Medical Center, 200 Corporate Boulevard South, Yonkers, NY, 10701, USA
| | - Charles J Neighbors
- Department of Health and Treatment Research and Analysis, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, 19th Floor, New York, NY, 10017, USA
| | - Joseph DeLuca
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Elenita M D'Aloia
- Montefiore Medical Group, Montefiore Medical Center, 305 E 161st St, Bronx, NY, 10451, USA
| | - Arelis Diaz
- Montefiore Medical Group, Montefiore Medical Center, 305 E 161st St, Bronx, NY, 10451, USA
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
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16
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Gray J, Beatty JR, Svikis DS, Puder KS, Resnicow K, Konkel J, Rice S, McGoron L, Ondersma SJ. Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers. JMIR Mhealth Uhealth 2017; 5:e172. [PMID: 29117931 PMCID: PMC5700401 DOI: 10.2196/mhealth.7927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/23/2017] [Accepted: 09/10/2017] [Indexed: 12/23/2022] Open
Abstract
Background Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate.
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Affiliation(s)
- Justin Gray
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Jessica R Beatty
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Karoline S Puder
- School of Medicine, Department of Obstetrics and Gynecology, Wayne State Unviersity, Detroit, MI, United States
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Janine Konkel
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Shetoya Rice
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Lucy McGoron
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Steven J Ondersma
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
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17
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Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians. J Addict Med 2017; 11:427-434. [DOI: 10.1097/adm.0000000000000340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Hickman M. Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review. BMC Public Health 2017; 17:562. [PMID: 28599632 PMCID: PMC5466741 DOI: 10.1186/s12889-017-4476-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people. METHODS This review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis. RESULTS From a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs. CONCLUSIONS There remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.
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Affiliation(s)
- Jane Derges
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Judi Kidger
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Fiona Fox
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Rona Campbell
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Matthew Hickman
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
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19
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Hellum R, Bjerregaard L, Nielsen AS. Factors influencing whether nurses talk to somatic patients about their alcohol consumption. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim Many Danes drink so much that it is detrimental to their health. As they are at risk of suffering diseases which can lead to hospitalisation on somatic wards, hospitals are ideal arenas for identifying individuals whose alcohol consumption is excessive. However, literature points out that this identification rarely takes place in hospitals, and literature further suggests that the staff experience barriers to talking about alcohol use with their patients. The primary aim of this study is to identify potential factors that influence whether or not nurses talk to patients about their alcohol consumption on somatic wards. Secondarily, we wish to examine whether a screening project may affect the nurses' readiness to talk about alcohol use with their patients. Methods A Glaserian Grounded Theory Method was used to collect and analyse data in this qualitative study. Semi-structured one-to-one interviews were conducted with seven nurses from somatic departments at two Danish hospitals. All seven nurses were already taking part in an alcohol screening project. Results In the analysis of the interview material, four categories emerged: The Nurse, The Patient, The Ward and The Relay Study. Conclusion We identified a series of barriers and promoting factors for nurses to talk about alcohol use with patients in a hospital setting. The barriers and promoting factors emerged within four categories: The Nurse, The Patient, The Ward, and The Relay Study. The most important barrier to talking to patients about alcohol seemed to be factors within the nurses themselves, in particular personal experiences, lack of knowledge and lack of confidence. We found, however, that by participating in a screening project the nurses seemed to overcome some of these barriers.
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Affiliation(s)
- Rikke Hellum
- Unit for Clinical Alcohol Research University of Southern Denmark
| | - Lene Bjerregaard
- Centre for Nursing and Bioanalytics University College Sjælland Denmark
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20
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Ellis DA, Idalski Carcone A, Ondersma SJ, Naar-King S, Dekelbab B, Moltz K. Brief Computer-Delivered Intervention to Increase Parental Monitoring in Families of African American Adolescents with Type 1 Diabetes: A Randomized Controlled Trial. Telemed J E Health 2017; 23:493-502. [PMID: 28061319 DOI: 10.1089/tmj.2016.0182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transition to independent diabetes care. INTRODUCTION The purpose of the study was to conduct a randomized clinical trial to test the feasibility and efficacy of a three-session, computer-delivered motivational intervention (The 3Ms) to promote increased parental monitoring among primary caregivers of young African American adolescents with T1D. The intervention was brief and optimized for delivery during routine diabetes clinic visits. MATERIALS AND METHODS Sixty-seven adolescents with T1D aged 11-14 and their primary caregiver were randomly assigned to one of three arms: adolescent and parent motivational intervention (Arm 1), adolescent control and parent motivational intervention (Arm 2), or adolescent and parent control (Arm 3). Intervention effects were assessed 1 month after intervention completion. RESULTS Parents in Arm 1 and Arm 2 had significant increases in knowledge of the importance of monitoring adolescents' diabetes care. Parents in Arm 2 also had trend to significant increases in direct observation and monitoring of adolescent diabetes care, and adolescents in Arm 2 had significant improvements in glycemic control. DISCUSSION AND CONCLUSIONS Findings from the present study provide preliminary support for the efficacy of a brief, computer-delivered parenting intervention for improving family management practices and adolescent health outcomes among African American adolescents with T1D and their caregivers.
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Affiliation(s)
- Deborah A Ellis
- 1 Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine , Detroit, Michigan
| | - April Idalski Carcone
- 1 Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine , Detroit, Michigan
| | - Steven J Ondersma
- 2 Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine , Detroit, Michigan
| | - Sylvie Naar-King
- 1 Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine , Detroit, Michigan
| | - Bassem Dekelbab
- 3 Department of Pediatrics, St. John Providence Health System , Detroit, Michigan
| | - Kathleen Moltz
- 4 Department of Pediatrics, Promedica Toledo Children's Hospital , Toledo, Ohio
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Coloma-Carmona A, Carballo JL, Tirado-González S. Barriers for identification and treatment of problem drinkers in primary care. GACETA SANITARIA 2016; 31:95-99. [PMID: 27751647 DOI: 10.1016/j.gaceta.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals' health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. METHOD The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. RESULTS The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. CONCLUSIONS Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care.
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Affiliation(s)
- Ainhoa Coloma-Carmona
- Centro de Psicología Aplicada, Universidad Miguel Hernández, Elche (Alicante), Spain.
| | - José Luis Carballo
- Centro de Psicología Aplicada, Universidad Miguel Hernández, Elche (Alicante), Spain
| | - Sonia Tirado-González
- Centro de Psicología Aplicada, Universidad Miguel Hernández, Elche (Alicante), Spain
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22
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[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 112:36-42. [PMID: 27172783 DOI: 10.1016/j.zefq.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.
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Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use. Drug Alcohol Rev 2016; 35:710-718. [PMID: 27004474 DOI: 10.1111/dar.12389] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 01/17/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-min, electronic screening and brief intervention (e-SBI) for alcohol use among postpartum women. DESIGN AND METHODS In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n = 61) or a time-matched control condition (n = 62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. RESULTS No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition versus 82% for control at 3 months (odds ratio = 1.6) and 72% versus 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. DISCUSSION AND CONCLUSIONS This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the 3-month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technology's reproducibility and modularity to isolate key components. [Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use. Drug Alcohol Rev 2016;35:710-718].
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Affiliation(s)
- Steven J Ondersma
- Department of Psychiatry and Behavioral Neurosciences and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, USA
| | | | | | - Jessica R Beatty
- Department of Psychiatry and Behavioral Neurosciences and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, USA
| | - Nancy Lockhart
- Department of Psychiatry and Behavioral Neurosciences and Merrill-Palmer Skillman Institute, Wayne State University, Detroit, USA
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Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. J Womens Health (Larchmt) 2016; 25:729-37. [PMID: 27387193 DOI: 10.1089/jwh.2015.5328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.
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Affiliation(s)
- Sarah Meshberg-Cohen
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Candice Presseau
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut
| | - Leroy R Thacker
- 3 Department of Family and Community Health Nursing, Virginia Commonwealth University , Richmond, Virginia
| | - Kathryn Hefner
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Dace Svikis
- 4 Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
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Rosário F, Wojnar M, Ribeiro C. Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in Portugal. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:3635907. [PMID: 26885392 PMCID: PMC4739209 DOI: 10.1155/2016/3635907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Introduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger (p = 0.005) and less experienced (p = 0.04) and with higher male proportion (p = 0.01). This group had more hours of postgraduate training (p < 0.001), felt more prepared to counsel risky drinkers (p < 0.001), and considered themselves to have better counselling efficacy (p < 0.001). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms (p = 0.01) and believed counselling is difficult (p = 0.005). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice.
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Affiliation(s)
- Frederico Rosário
- Preventive Medicine Institute, Faculty of Medicine of Lisbon, Edifício Egas Moniz, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
- Tomaz Ribeiro's Primary Health Care Center, Avenida 25 de Abril, 3460-541 Tondela, Portugal
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Cristina Ribeiro
- Preventive Medicine Institute, Faculty of Medicine of Lisbon, Edifício Egas Moniz, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
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Miquel L, Barrio P, Moreno-España J, Ortega L, Manthey J, Rehm J, Gual A. [Detection and prevalence of alcohol use disorders in primary health care in Catalonia]. Aten Primaria 2015; 48:175-82. [PMID: 26455328 PMCID: PMC6877858 DOI: 10.1016/j.aprim.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022] Open
Abstract
Objetivo Describir el grado de reconocimiento del trastorno por uso de alcohol (TUA) y dependencia de alcohol por los médicos de atención primaria (MAP) y determinar su prevalencia. Diseño Estudio transversal. Emplazamiento Veinte centros de atención primaria de Cataluña. Participantes y mediciones Se encuestó a 23 MAP seleccionados al azar acerca del consumo de alcohol y otras enfermedades de sus pacientes. Se entrevistó y evaluó a 1.372 pacientes con la Composite International Diagnostic Interview (CIDI) para determinar el diagnóstico de TUA en el último año, y otros cuestionarios (el K10, de cribado, y el World Health Organization Disability Assessment Schedule 2.0) para evaluar la discapacidad y la salud mental. Resultados La CIDI diagnosticó TUA en un 9,6% del total de la muestra. Los MAP detectaron un 4,8% de TUA. La CIDI detectó mayor proporción de casos entre las edades más jóvenes, y el MAP detectó mayor porcentaje de TUA y dependencia de alcohol en personas de mayor edad y con enfermedades concomitantes. Los MAP identificaron el 28,8% de los casos diagnosticados de TUA por la CIDI. El 42,4% de los pacientes diagnosticados por el MAP no fueron identificados por la CIDI. Al utilizar como criterio diagnóstico indistintamente la CIDI o la impresión clínica del MAP, la prevalencia de TUA en atención primaria se situó en el 11,7%, y la de dependencia de alcohol, en el 8,6%. Conclusiones Los MAP reconocen poco el TUA en gente joven, mientras que detectan más la enfermedad en pacientes de mayor edad y con comorbilidades asociadas. La prevalencia de TUA es elevada en atención primaria.
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Affiliation(s)
- Laia Miquel
- Grup de Recerca en Addiccions Clínic (GRAC), Unidad de Conductas Adictivas, Departamento de Psiquiatría, Instituto Clínico de Neurociencias, Hospital Clínico Universitario de Barcelona, Universidad de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Red de Trastornos Adictivos (RTA), Barcelona, España.
| | - Pablo Barrio
- Grup de Recerca en Addiccions Clínic (GRAC), Unidad de Conductas Adictivas, Departamento de Psiquiatría, Instituto Clínico de Neurociencias, Hospital Clínico Universitario de Barcelona, Universidad de Barcelona, Barcelona, España; Red de Trastornos Adictivos (RTA), Barcelona, España
| | - Jose Moreno-España
- Grup de Recerca en Addiccions Clínic (GRAC), Unidad de Conductas Adictivas, Departamento de Psiquiatría, Instituto Clínico de Neurociencias, Hospital Clínico Universitario de Barcelona, Universidad de Barcelona, Barcelona, España
| | - Lluisa Ortega
- Grup de Recerca en Addiccions Clínic (GRAC), Unidad de Conductas Adictivas, Departamento de Psiquiatría, Instituto Clínico de Neurociencias, Hospital Clínico Universitario de Barcelona, Universidad de Barcelona, Barcelona, España; Red de Trastornos Adictivos (RTA), Barcelona, España
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresde, Alemania
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresde, Alemania; Centre for Addiction and Mental Health, Toronto, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic (GRAC), Unidad de Conductas Adictivas, Departamento de Psiquiatría, Instituto Clínico de Neurociencias, Hospital Clínico Universitario de Barcelona, Universidad de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Red de Trastornos Adictivos (RTA), Barcelona, España
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Rajkumar D, Ellis DA, May DK, Carcone A, Naar-King S, Ondersma S, Moltz KC. Computerized Intervention to Increase Motivation for Diabetes Self-Management in Adolescents with Type 1 Diabetes. Health Psychol Behav Med 2015; 3:236-250. [PMID: 26973800 DOI: 10.1080/21642850.2015.1079716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Dixy Rajkumar
- Pediatric Prevention Research Center, Wayne State University
| | - Deborah A Ellis
- Pediatric Prevention Research Center, Wayne State University
| | - Dana K May
- Pediatric Prevention Research Center, Wayne State University
| | - April Carcone
- Pediatric Prevention Research Center, Wayne State University
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Mitchell SG, Schwartz RP, Kirk AS, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O'Grady KE, Brown BS. SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers. J Subst Abuse Treat 2015; 60:81-90. [PMID: 26297321 DOI: 10.1016/j.jsat.2015.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. METHODS This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DISCUSSION The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Dunlap
- RTI International, Research Triangle Park, NC USA
| | | | - Kevin E O'Grady
- University of Maryland, College Park, Department of Psychology, College Park, MD USA
| | - Barry S Brown
- Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA
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29
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Affiliation(s)
- Anne Moyer
- Stony Brook University (Moyer), Stony Brook, NY; Center for Innovation to Implementation (Finney), VA Palo Alto Health Care System, Menlo Park, Calif.
| | - John W Finney
- Stony Brook University (Moyer), Stony Brook, NY; Center for Innovation to Implementation (Finney), VA Palo Alto Health Care System, Menlo Park, Calif
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30
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Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev 2015; 34:487-494. [PMID: 25693922 DOI: 10.1111/dar.12243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/20/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND AIMS Attitudes to individuals presenting with alcohol-related issues are important in developing therapeutic relationships and applying alcohol-related interventions. This study explores staff attitudes to these individuals across a range of roles and departments. DESIGN AND METHODS Data were gathered from 204 staff in the Southern Health and Social Care Trust in Northern Ireland. Regression models were used to predict attitudes as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). RESULTS Two hundred and four people participated in the study. The sample comprised doctors, nurses, allied health professionals and other staff who had face-to-face contact with patients. Staff worked in accident and emergency (A&E), medical, surgical, addiction or psychiatry departments. Staff working in addiction and psychiatry departments had significantly higher levels of role adequacy compared with those in A&E. Staff in addictions also demonstrated higher levels of role legitimacy, motivation and role satisfaction than those in A&E. Doctors had higher role adequacy and role legitimacy than nursing staff. DISCUSSION AND CONCLUSIONS There are critical differences in staff attitudes to patients presenting with alcohol-related issues in a range of hospital settings; training and working in a specialist setting have a significant positive influence on staff attitudes. This suggests that further training and support would positively enhance the attitudes of staff in a variety of professional roles and across a range of hospital settings in the management of patients presenting with alcohol-related difficulties. [Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev 2015;34:487-94].
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Affiliation(s)
- Nauman Iqbal
- Home Treatment Team Department, St Luke's Hospital, Armagh, UK
| | | | - Lauren Edgar
- Bluestone Unit, Craigavon Area Hospital, Portadown, UK
| | - Ciara Young
- Old Age Psychiatry Department, Knockbracken Healthcare Park, Belfast, UK
| | - Gillian W Shorter
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Londonderry, UK.,MRC All Ireland Trials Methodology Hub, Ulster University, Londonderry, UK
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Pollick SA, Beatty JR, Sokol RJ, Strickler RC, Chang G, Svikis DS, Tzilos GK, Ondersma SJ. Acceptability of a computerized brief intervention for alcohol among abstinent but at-risk pregnant women. Subst Abus 2015; 36:13-20. [PMID: 24266770 DOI: 10.1080/08897077.2013.857631] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Limitations in time and training have hindered widespread implementation of alcohol-based interventions in prenatal clinics. Also, despite the possibility of underreporting or relapse, many at-risk women report that they quit drinking after pregnancy confirmation so that interventions focusing on current drinking may seem unnecessary. The Computerized Brief Intervention for Alcohol Use in Pregnancy (C-BIAP) was designed to (a) be implemented via a handheld device in prenatal clinics, and (b) use a modified brief intervention strategy with women who screen at-risk but report no current drinking. METHODS The authors administered the C-BIAP to 18 T-ACE (Tolerance, Annoyance, Cut Down, and Eye Opener)-positive pregnant African American women who provided quantitative and qualitative feedback. RESULTS The C-BIAP received high ratings of acceptability; qualitative feedback was also positive overall and suggested good acceptance of abstinence themes. CONCLUSIONS Technology may be a feasible and acceptable method for brief intervention delivery with pregnant women who do not report current drinking.
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Affiliation(s)
- Sarah A Pollick
- a Department of Psychiatry and Behavioral Neuroscience, Wayne State University , Detroit , Michigan , USA
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32
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Idalski Carcone A, Ellis DA, Naar S, Ondersma SJ, Moltz K, Dekelbab B, Joseph CL. Enhancing parental motivation to monitor african american adolescents' diabetes care: development and Beta test of a brief computer-delivered intervention. JMIR Res Protoc 2014; 3:e43. [PMID: 25236503 PMCID: PMC4180328 DOI: 10.2196/resprot.3220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/14/2014] [Accepted: 07/18/2014] [Indexed: 11/24/2022] Open
Abstract
Background African American youth are at increased risk for poor diabetes management. Parenting behaviors such as parental monitoring are significant predictors of youth diabetes management and metabolic control, but no intervention has targeted parental monitoring of daily diabetes care. Objective The purpose of the present study was to develop and pilot test a three-session computer-delivered intervention to enhance parental motivation to monitor African American pre-adolescents’ diabetes management. Methods The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills (IMB) model of health behavior change and Motivational Interviewing approaches. Five caregivers of African American youth aged 10-13 years diagnosed with type 1 diabetes for a minimum of one year (ie, the target population) reviewed the intervention and provided feedback via semi-structured interviews. Interviews were transcribed and analyzed using thematic analysis. Results Caregivers’ responses to interview questions suggest that The 3 Ms was helpful (minimum rating was 8 out of 10) and they would recommend the program to another parent of a child with diabetes (minimum rating was 9 out of 10). Three of five reported that The 3 Ms program increased the likelihood that they would talk to their child about diabetes. Thematic analysis suggested two primary themes: caregivers found the intervention to be a useful reminder of the importance of supervising their child’s diabetes care and that it evoked a feeling of shared experience with other parents. Conclusions The 3 Ms computer-delivered intervention for increasing parental monitoring of African-American youth with type 1 diabetes was well-received and highly rated by a small sample of representative caregivers. Trial Registration ClinicalTrials.gov NCT01515930; http://clinicaltrials.gov/ct2/show/NCT01515930 (Archived by WebCite at http://www.webcitation.org/6Rm0vq9pn).
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Affiliation(s)
- April Idalski Carcone
- Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States.
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Heather N. Interpreting null findings from trials of alcohol brief interventions. Front Psychiatry 2014; 5:85. [PMID: 25076917 PMCID: PMC4100216 DOI: 10.3389/fpsyt.2014.00085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/03/2014] [Indexed: 12/03/2022] Open
Abstract
The effectiveness of alcohol brief intervention (ABI) has been established by a succession of meta-analyses but, because the effects of ABI are small, null findings from randomized controlled trials are often reported and can sometimes lead to skepticism regarding the benefits of ABI in routine practice. This article first explains why null findings are likely to occur under null hypothesis significance testing (NHST) due to the phenomenon known as "the dance of the p-values." A number of misconceptions about null findings are then described, using as an example the way in which the results of the primary care arm of a recent cluster-randomized trial of ABI in England (the SIPS project) have been misunderstood. These misinterpretations include the fallacy of "proving the null hypothesis" that lack of a significant difference between the means of sample groups can be taken as evidence of no difference between their population means, and the possible effects of this and related misunderstandings of the SIPS findings are examined. The mistaken inference that reductions in alcohol consumption seen in control groups from baseline to follow-up are evidence of real effects of control group procedures is then discussed and other possible reasons for such reductions, including regression to the mean, research participation effects, historical trends, and assessment reactivity, are described. From the standpoint of scientific progress, the chief problem about null findings under the conventional NHST approach is that it is not possible to distinguish "evidence of absence" from "absence of evidence." By contrast, under a Bayesian approach, such a distinction is possible and it is explained how this approach could classify ABIs in particular settings or among particular populations as either truly ineffective or as of unknown effectiveness, thus accelerating progress in the field of ABI research.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University , Newcastle upon Tyne , UK
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O'Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, Kaner E. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol 2013; 49:66-78. [PMID: 24232177 PMCID: PMC3865817 DOI: 10.1093/alcalc/agt170] [Citation(s) in RCA: 347] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.
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Affiliation(s)
- Amy O'Donnell
- Corresponding author: Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AX, UK.
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35
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Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: a randomized trial. J Subst Abuse Treat 2013; 46:52-9. [PMID: 24051077 DOI: 10.1016/j.jsat.2013.07.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/28/2013] [Accepted: 07/21/2013] [Indexed: 11/24/2022]
Abstract
Electronic screening and brief intervention (e-SBI) approaches for substance use have shown early promise. This trial was designed to replicate previous findings from a single 20-minute e-SBI for drug use among postpartum women. A total of 143 postpartum, primarily low-income African-American women meeting criteria for drug use, were randomly assigned to either a tailored e-SBI or a time-matched control condition. Blinded follow-up evaluation 3- and 6-months following childbirth revealed strong effects for confirmed illicit drug use abstinence at the 3-month observation (OR=3.3, p=.01), as did hair analysis at 6months (OR=4.8, p=.018). Additional primary outcomes suggested small to moderate effect sizes in favor of the e-SBI, but did not reach significance. This result replicates previous findings but fails to show durable effects. Assessment reactivity, e-SBI design, and possible extension of e-SBI via tailored messaging all merit careful consideration.
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El Ansari W, Dunne J. Case study of cognitive behavioural therapy awareness educational programme using blended learning, UK. J Psychiatr Ment Health Nurs 2013; 20:50-63. [PMID: 22369589 DOI: 10.1111/j.1365-2850.2012.01879.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper examined the opportunities as well as challenges in relation to the use of cognitive behavioural therapy (CBT). The opportunities include the increased range of mental health conditions and other disorders where CBT (in isolation or with other interventions) could be effective to address them, as well as policies around workforce education and training that support the expansion of psychological therapies, particularly CBT services. The challenges include the urgent need of heightened awareness among the wider platform of health and social care workers about CBT principles, structure, framework, methods of delivery, wider applications, evaluation and appropriate referral of clients, and stepped model of care. In response to such needs, the paper described CBT awareness educational award at the University of Gloucestershire, UK: the Certificate of Professional Studies in Awareness of Cognitive and Behavioural Therapies Practice delivered at Level III and M level. The challenges associated with the initiation and running of such educational programmes are highlighted, as well as suggestions for the way forward considering the learners', employers' and educational providers' perspectives.
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Affiliation(s)
- W El Ansari
- Professor, Faculty of Applied Sciences, University of Gloucestershire, Gloucester Senior Lecturer, Faculty of Business, Education and Professional Services, University of Gloucestershire, Cheltenham, UK.
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Bray JW, Zarkin GA, Hinde JM, Mills MJ. Costs of alcohol screening and brief intervention in medical settings: a review of the literature. J Stud Alcohol Drugs 2013; 73:911-9. [PMID: 23036208 DOI: 10.15288/jsad.2012.73.911] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This article summarizes the literature on the implementation costs of alcohol screening and brief intervention (SBI) in medical settings. METHOD Electronic databases were searched using SBI- and cost-related terms. Methodological approaches and cost estimates were abstracted from each study and categorized based on the cost methodology. Costs were updated to 2009 U.S. dollars. To determine a summary cost measure, we excluded outliers and computed the median of the remaining cost estimates. RESULTS Seventeen studies with cost estimates were identified for further study. Costs ranged from $0.51 to $601.50 per screen and from $3.41 to $243.01 per brief intervention (BI). Cost estimates were lower when an activity-based cost methodology was used, in primary care settings, and when the provider was not a doctor. The median summary cost of a screen is approximately $4, and the median summary cost of a BI is approximately $48. CONCLUSIONS Screening cost estimates had more variation than BI cost estimates. Provider type and service delivery time drive the cost variation. Interpretation of cost differences was limited by insufficient reporting of the cost methodology. Cost estimates presented here are similar in size to the Healthcare Common Procedure Coding System and Current Procedural Terminology reimbursement amounts, suggesting that insurance-based service reimbursement may be sufficient to sustain alcohol SBI in practice.
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Affiliation(s)
- Jeremy W Bray
- RTI International, Research Triangle Park, North Carolina.
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McCallum AK, Manderbacka K, Arffman M, Leyland AH, Keskimäki I. Socioeconomic differences in mortality amenable to health care among Finnish adults 1992-2003: 12 year follow up using individual level linked population register data. BMC Health Serv Res 2013; 13:3. [PMID: 23286878 PMCID: PMC3602718 DOI: 10.1186/1472-6963-13-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/23/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Finland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003. METHODS We analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles. RESULTS Between 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care. CONCLUSIONS Our findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention.
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Affiliation(s)
- Alison K McCallum
- Directorate of Public Health and Health Policy, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG, Scotland
| | - Kristiina Manderbacka
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
| | - Martti Arffman
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Ilmo Keskimäki
- National Institute for Health and Welfare, (THL), P.O. Box 30, Helsinki, FI-00271, Finland
- School of Health Sciences, University of Tampere, Kalevantie 4, Tampere, 33014, Finland
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Egerer M. Alcoholism, brief intervention and the institutional context: a focus-group study with French and Finnish general practitioners. CRITICAL PUBLIC HEALTH 2012. [DOI: 10.1080/09581596.2011.637901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Clifford A, Shakeshaft A, Deans C. Training and tailored outreach support to improve alcohol screening and brief intervention in Aboriginal Community Controlled Health Services. Drug Alcohol Rev 2012; 32:72-9. [PMID: 22775591 DOI: 10.1111/j.1465-3362.2012.00488.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 05/31/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Aboriginal Community Controlled Health Services (ACCHSs) are often the primary point of contact for Indigenous Australians experiencing alcohol-related harms. Screening and brief intervention (SBI) is a cost-effective treatment for reducing these harms. Factors influencing evidence-based alcohol SBI delivery in ACCHSs have been identified. Evaluations of strategies targeting these factors are required. The aim of this paper is to quantify the effect of training and tailored outreach support on the delivery of alcohol SBI in four Aboriginal Community Controlled Health Services (ACCHSs). DESIGN AND METHODS A pre- post- assessment of alcohol information recorded in computerised patient information systems of four ACCHSs. RESULTS For ACCHSs combined there was a statistically significant increase in the proportion of eligible clients with an electronic record of any alcohol information (3.2% to 7.5%, P < 0.0001) and a valid alcohol screen (1.6% to 6.5%, P < 0.0001), and brief intervention (25.75% to 47.7%, P < 0.0001). All four ACCHSs achieved statistically significant increases in the proportion of clients with a complete alcohol screen (10.3%; 7.4%; 2%, P < 0.0001 and 1.3%, P < 0.05), and two in the proportion with a heavy drinking screen (7% and 3.1%, P < 0.0001). DISCUSSION AND CONCLUSIONS Implementing evidence-based alcohol SBI in ACCHSs is likely to require multiple strategies tailored to the characteristics of specific services. Outreach support provided by local drug and alcohol practitioners and a one item heavy drinking screen offer considerable promise for increasing routine alcohol SBI delivery in ACCHSs. Training and outreach support appear to be effective for achieving modest improvements in alcohol SBI delivery in ACCHSs.
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Affiliation(s)
- Anton Clifford
- School of Population Health, Faculty of Health Science, University of Queensland, Brisbane, Australia.
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Seppänen KK, Aalto M, Seppä K. Institutionalization of brief alcohol intervention in primary health care-the Finnish case. Alcohol Clin Exp Res 2012; 36:1456-61. [PMID: 22404105 DOI: 10.1111/j.1530-0277.2012.01755.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 12/08/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND There have been several research and practical projects to promote alcohol brief interventions (BIs) in healthcare settings, but no reports of nationwide outcome have so far been published. In Finland, these activities started in the early 1990s, and in the past years, the focus has been mainly on primary and occupational health care. The aim of the present study was to ascertain whether the extensive and long-lasting implementation efforts have led to the institutionalization of this activity among primary healthcare physicians and to the identification of factors that may be associated with it. METHODS The data were gathered by a questionnaire sent to all Finnish primary healthcare physicians in 2002 and 2007. In both years, the questionnaire contained questions on demographics, professional background and the physicians' own BI activity (regular, occasional, or none). In 2007, a question eliciting information about the change in BI activity during the past 5 years was added. The response rate was 67.1% (95% CI 65.4 to 68.8) (2,001/2,980) in 2002 and 50.9% (95% CI 49.2 to 52.6) (1,610/3,163) in 2007. RESULTS The number of physicians offering BI had increased during the study years from 59.2 to 78.5%. Regular activity was reported in 2002 by 9.3% of physicians and in 2007 by 17.2% and occasional activity correspondingly by 49.9 and 61.3%. Of the physicians who offered BI in 2007, 52.4% reported increased activity and 42.6% similar activity to that reported 5 years earlier. Having a specialist's license in general practice or occupational health care or long experience as a primary healthcare physician predicted high activity. CONCLUSIONS The BI activity of Finnish primary healthcare physicians is reasonably high and rising. Training and motivating those with low BI activity remains future challenge.
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Affiliation(s)
- Kati K Seppänen
- Co-operation Area for Health Care Services in Jyväskylä, Finland.
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Rudzinski K, McGuire F, Dawe M, Shuper P, Bilsker D, Capler R, Rehm J, Fischer B. Brief Intervention Experiences of Young High-Frequency Cannabis Users in a Canadian Setting. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/009145091203900104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-frequency cannabis use is prevalent among young adults and has been linked to negative health consequences, yet effective therapeutic interventions are currently limited. Brief Interventions (BIs) for problematic substance use have shown promise, but are typically limited to quantitative outcome measures. This study aims to document the qualitative experiences of young, high-frequency cannabis users with BIs. Sixty-two high-frequency cannabis users, recruited from university student populations, participated in one of two newly developed cannabis BIs and were surveyed qualitatively at the 3-month post-intervention follow-up. Results show that 69.4% of the respondents believed they had undergone changes in actions/thinking/attitudes regarding their cannabis use, with diversion to potentially less harmful cannabis use patterns—including reductions in the frequency/quantity of use and declines in deep-inhalation/breath-holding techniques—being reported. Findings suggest that a personalized, interactive, culturally appropriate format may be a promising BI template for this population. Future qualitative research on BI experiences is urgently needed.
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NEHLIN CHRISTINA, FREDRIKSSON ANDERS, GRÖNBLADH LEIF, JANSSON LENNART. Three hours of training improve psychiatric staff's self-perceived knowledge and attitudes toward problem-drinking patients. Drug Alcohol Rev 2011; 31:544-9. [DOI: 10.1111/j.1465-3362.2011.00373.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wilson GB, Lock CA, Heather N, Cassidy P, Christie MM, Kaner EFS. Intervention against excessive alcohol consumption in primary health care: a survey of GPs' attitudes and practices in England 10 years on. Alcohol Alcohol 2011; 46:570-7. [PMID: 21690169 PMCID: PMC3156887 DOI: 10.1093/alcalc/agr067] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/17/2011] [Accepted: 05/18/2011] [Indexed: 11/24/2022] Open
Abstract
AIMS To ascertain the views of general practitioners (GPs) regarding the prevention and management of alcohol-related problems in practice, together with perceived barriers and incentives for this work; to compare our findings with a comparable survey conducted 10 years earlier. METHODS In total, 282 (73%) of 419 GPs surveyed in East Midlands, UK, completed a postal questionnaire, measuring practices and attitudes, including the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). RESULTS GPs reported lower levels of post-graduate education or training on alcohol-related issues (<4 h for the majority) than in 1999 but not significantly so (P = 0.031). In the last year, GPs had most commonly requested more than 12 blood tests and managed 1-6 patients for alcohol. Reports of these preventive practices were significantly increased from 1999 (P < 0.001). Most felt that problem or dependent drinkers' alcohol issues could be legitimately (88%, 87%) and adequately (78%, 69%) addressed by GPs. However, they had low levels of motivation (42%, 35%), task-related self-esteem (53%, 49%) and job satisfaction (15%, 12%) for this. Busyness (63%) and lack of training (57%) or contractual incentives (48%) were key barriers. Endorsement for government policies on alcohol was very low. CONCLUSION Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice.
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Affiliation(s)
- Graeme B Wilson
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK.
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Williams EC, Bryson CL, Sun H, Chew RB, Chew LD, Blough DK, Au DH, Bradley KA. Association between Alcohol Screening Results and Hospitalizations for Trauma in Veterans Affairs Outpatients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 38:73-80. [DOI: 10.3109/00952990.2011.600392] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Emily C. Williams
- Health Services Research & Development (HSR&D) Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington,
Seattle, WA, USA
| | - Chris L. Bryson
- Health Services Research & Development (HSR&D) Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington,
Seattle, WA, USA
| | - Haili Sun
- Health Services Research & Development (HSR&D) Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Ryan B. Chew
- Overlake Hospitalist Practice, Overlake Hospital Medical Center,
Bellevue, WA, USA
| | - Lisa D. Chew
- Department of Medicine, University of Washington,
Seattle, WA, USA
- Adult Medicine Clinic, Harborview Medical Center,
Seattle, WA, USA
| | - David K. Blough
- Department of Pharmacy, University of Washington,
Seattle, WA, USA
| | - David H. Au
- Health Services Research & Development (HSR&D) Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington,
Seattle, WA, USA
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington,
Seattle, WA, USA
- Department of Medicine, University of Washington,
Seattle, WA, USA
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Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict 2011; 20:343-56. [PMID: 21679266 DOI: 10.1111/j.1521-0391.2011.00143.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Brief physician interventions can reduce alcohol consumption. Physicians may not have the time to provide brief interventions, and it is unclear whether nonphysicians can do so effectively. We conducted a systematic review and meta-analysis to examine the efficacy of brief interventions by nonphysician clinicians for unhealthy alcohol use. We searched the English-language literature in MEDLINE and other databases covering the domains of alcohol problems, primary care, nonphysician, and brief interventions. Studies of brief interventions delivered at least in part by nonphysicians in primary care and examining drinking outcomes were included. Sensitivity analyses examined the effect of excluding studies that contributed disproportionately to the heterogeneity of results. Thirteen studies, conducted 1996-2008, met our criteria. Seven studies with a total of 2,633 patients were included in the meta-analysis. Nonphysician interventions were associated with 1.7 (95% confidence interval [CI]=-.03 to -3.5) fewer standard drinks per week than control conditions (p = .054). Excluding the one study that increased heterogeneity, the effect was smaller but reached statistical significance; nonphysician counseling was associated with 1.4 (95% CI = .3- 2.4) fewer standard drinks per week compared to control (p = .012). Nonphysician brief interventions are modestly effective at reducing drinking in primary care patients with unhealthy alcohol use.
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Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, Connecticut 06520–8093, USA.
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Delivering alcohol screening and alcohol brief interventions within general dental practice: rationale and overview of the evidence. Br Dent J 2011; 210:E15. [PMID: 21566582 DOI: 10.1038/sj.bdj.2011.363] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2010] [Indexed: 11/09/2022]
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CLIFFORD ANTON, SHAKESHAFT ANTHONY, DEANS CATHERINE. How and when health-care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: A qualitative study. Drug Alcohol Rev 2011; 31:13-9. [DOI: 10.1111/j.1465-3362.2011.00305.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs. Alcohol Alcohol 2011; 46:283-91. [DOI: 10.1093/alcalc/agr021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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