Predictors of study setting (primary care vs. hospital setting) among studies of the effectiveness of brief interventions among heavy alcohol users: A systematic review

Reducing bias in trials from reactions to measurement: the MERIT study including developmental work and expert workshop

BACKGROUND

Measurement can affect the people being measured; for example, asking people to complete a questionnaire can result in changes in behaviour (the 'question-behaviour effect'). The usual methods of conduct and analysis of randomised controlled trials implicitly assume that the taking of measurements has no effect on research participants. Changes in measured behaviour and other outcomes due to measurement reactivity may therefore introduce bias in otherwise well-conducted randomised controlled trials, yielding incorrect estimates of intervention effects, including underestimates.

OBJECTIVES

The main objectives were (1) to promote awareness of how and where taking measurements can lead to bias and (2) to provide recommendations on how best to avoid or minimise bias due to measurement reactivity in randomised controlled trials of interventions to improve health.

METHODS

We conducted (1) a series of systematic and rapid reviews, (2) a Delphi study and (3) an expert workshop. A protocol paper was published [Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, McCambridge J, et al. Bias due to MEasurement Reactions In Trials to improve health (MERIT): protocol for research to develop MRC guidance. Trials 2018;19:653]. An updated systematic review examined whether or not measuring participants had an effect on participants' health-related behaviours relative to no-measurement controls. Three new rapid systematic reviews were conducted to identify (1) existing guidance on measurement reactivity, (2) existing systematic reviews of studies that have quantified the effects of measurement on outcomes relating to behaviour and affective outcomes and (3) experimental studies that have investigated the effects of exposure to objective measurements of behaviour on health-related behaviour. The views of 40 experts defined the scope of the recommendations in two waves of data collection during the Delphi procedure. A workshop aimed to produce a set of recommendations that were formed in discussion in groups.

RESULTS

Systematic reviews - we identified a total of 43 studies that compared interview or questionnaire measurement with no measurement and these had an overall small effect (standardised mean difference 0.06, 95% confidence interval 0.02 to 0.09; n = 104,096, I² = 54%). The three rapid systematic reviews identified no existing guidance on measurement reactivity, but we did identify five systematic reviews that quantified the effects of measurement on outcomes (all focused on the question-behaviour effect, with all standardised mean differences in the range of 0.09-0.28) and 16 studies that examined reactive effects of objective measurement of behaviour, with most evidence of reactivity of small effect and short duration. Delphi procedure - substantial agreement was reached on the scope of the present recommendations. Workshop - 14 recommendations and three main aims were produced. The aims were to identify whether or not bias is likely to be a problem for a trial, to decide whether or not to collect further quantitative or qualitative data to inform decisions about if bias is likely to be a problem, and to identify how to design trials to minimise the likelihood of this bias.

LIMITATION

The main limitation was the shortage of high-quality evidence regarding the extent of measurement reactivity, with some notable exceptions, and the circumstances that are likely to bring it about.

CONCLUSION

We hope that these recommendations will be used to develop new trials that are less likely to be at risk of bias.

FUTURE WORK

The greatest need is to increase the number of high-quality primary studies regarding the extent of measurement reactivity.

STUDY REGISTRATION

The first systematic review in this study is registered as PROSPERO CRD42018102511.

FUNDING

Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council-National Institute for Health Research Methodology Research Programme.

SBIRT administered by mental health counselors for hospitalized adults with substance misuse or disordered use: Evaluating hospital utilization and costs

OBJECTIVE

We analyzed the association of Screening, Brief Intervention, and Referral to Treatment (SBIRT) with hospitalizations, emergency department (ED) visits, and related costs, when administered to inpatients with substance misuse or disordered use by professional mental health counselors.

METHODS

Our study used retrospective program and health records data and a difference-in-differences design with propensity score covariates. The study population consisted of hospital inpatients admitted to integrated care services staffed by physicians, nurses, and mental health counselors. The intervention group consisted of patients selected for intervention based on substance use history and receiving SBIRT (n = 1577). Patients selected for intervention but discharged before SBIRT administration (n = 618) formed the comparison group. The outcome variables were hospitalization and ED visits costs and counts. Costs of hospitalizations and ED visits were combined to allow sufficient data for analysis, with counts treated similarly. Patient-level variables were substance use type and substance use severity. A cluster variable was inpatient clinical service. Zero-censored and two-part logistic and generalized linear models with robust standard errors tested the association of SBIRT interventions with the outcomes.

RESULTS

For the full study population of patients using alcohol, illicit drugs, or both, SBIRT administered by mental health counselors was not associated with changes in hospitalizations and ED visits. For patients with alcohol misuse or disordered use, SBIRT by mental health counselors was associated an odds ratio of 0.32 (p < .001) of having subsequent hospitalizations or ED visits. For patients with alcohol use who did return as hospital inpatients or to the ED, SBIRT by counselors was associated with a reduction in costs of $2547 per patient (p < .001) and with an incidence rate ratio of 0.57 for counts (p = .003).

CONCLUSION

Our results suggest that professional mental health counselors on inpatient integrated care teams may provide SBIRT effectively for patients with misuse and disordered use of alcohol, reducing the likelihood of future healthcare utilization and costs.

REDUCTION OF THE ALCOHOL CONSUMPTION AMONG WORKERS USING A BRIEF INTERVENTION

ABSTRACT Objective: to analyze the effect of a brief intervention on the reduction of the alcohol consumption pattern among workers from the worker health perspective. Methods: a quasi-experimental study with a single sample of 36 workers, applying the positive (>8) Alcohol Use Disorders Identification Test and sample selection and using data from the Worker Health Booklet in combination with the mentioned test. Participants had three weekly sessions of brief intervention with motivational interviewing and were reevaluated after three months. Data were analyzed quantitatively. The Wilcoxon test was applied to data on the reduction of the consumption pattern, and a significance p<0.05 was adopted. Results: risky consumption prevailed (61.1%), followed by probable dependence (27.8%) and hazardous consumption (11.1%). The score obtained in the test after three months of the brief intervention was lower than the initial result, with Z=-4.709 and p<0.000. Regarding sociodemographic and occupational characteristics, all the participants showed a significant reduction. Concerning Alcohol Use Disorders Identification Test questions, there was a reduction, especially in the frequency (Z=-3.880 and p<0.000) and binge drinking (Z=-4.144 and p<0.000). Conclusion: the effect of brief intervention associated with motivational interviewing reduced the alcohol consumption pattern among workers at a public university.

The Acceptability and Feasibility of Screening for Alcohol and Drug Misuse in a Hospital Emergency Department

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Objectives:

Screening and brief intervention (SBI) is an evidence-based technique for reducing harmful consumption of alcohol and other drugs, which has been shown to be effective in Emergency Departments (EDs). The feasibility of SBI in the ED, however, remains contentious and no studies have been conducted on this topic in a New Zealand ED.

Materials and Methods:

This study recruited 8 experienced ED nurses who attempted to provide SBI, using the ASSIST-Lite tool, to as many of their patients as possible over one calendar month. All nurses participated in a comprehensive 1-day training workshop on the administration and interpretation of the ASSIST-Lite and linked brief intervention.

Results:

Only 46 (11.79%) of the 390 eligible patients were given the opportunity to participate over the data collection period. Analysis of the data showed there was a significant, negative correlation between the number of patients in the ED and the average number of screens that were performed by the nurses, and that the number of screens waned immediately after SBI training. Following the data collection period, the nurse participants were interviewed about their experience. These interviews revealed 3 main themes that contextualized the willingness to, but inherent difficulty of, administering the SBI within the ED environment.

Conclusions:

High patient-to-nurse ratios in the ED currently preclude nurses from providing consistent SBI to all eligible patients; however, there are several practical considerations highlighted here that might help nurses increase the participation rate.

Who benefits from computer-based brief alcohol intervention? Day-to-day drinking patterns as a moderator of intervention efficacy

OBJECTIVE

to test if people with different day-to-day drinking patterns benefitted differently from two brief alcohol interventions (BAIs).

METHODS

A total of 1243 job-seekers with at-risk alcohol use aged 18-64 years (64% men) were randomized to (a) intervention tailored to the motivational stage (ST), (b) non-stage tailored intervention (NST), or (c) assessment only (AO). ST and NST contained individualized computer-generated feedback letters. Follow-ups were conducted at months 3, 6, and 15. Using growth mixture models, day-to-day drinking patterns were identified based on the number of drinks consumed on each day in the week prior to baseline assessment. To test drinking pattern-specific intervention effects, zero-inflated growth models were used. Outcomes were (1) the 15-month change in the likelihood of any alcohol use and (2) the 15-month change in the total number of drinks per week when alcohol was consumed.

RESULTS

Four day-to-day drinking patterns were found: daily medium use (2-4 drinks/day; 47%), daily low use (1-2 drinks/day; 29%), weekend only use (18%), and no use (6%). Only persons with daily low use benefitted from intervention, with higher odds of being abstinent after 15 months in the ST group compared to AO (odds ratio, OR=1.67, p=0.001) and NST group (OR=1.43, p=0.035). ST worked better among persons with daily low use compared to daily medium use (OR=1.91, p=0.001).

CONCLUSIONS

Among at-risk drinking persons with regular low-quantity alcohol use, stage tailored BAIs may be superior over no BAI and non-stage tailored BAIs.

PROFILE OF CONSUMPTION OF PSYCHOACTIVE SUBSTANCES AND ITS RELATIONSHIP TO SOCIODEMOGRAPHIC CHARACTERISTICS: A CONTRIBUTION TO A BRIEF INTERVENTION IN PRIMARY HEALTH CARE, RIO DE JANEIRO, BRAZIL

ABSTRACT The aim of this study was to analyze the profile of consumption of psychoactive substances in the past three months and their association with sociodemographic variables. A cross-sectional study was conducted with users of the Family Health Strategy in the perspective of the brief intervention, in the city of Rio de Janeiro, Brazil. The sample included 1,489 users of the service interviewed throughout a year. The consumption of substances was assessed through the questionnaire Alcohol, Smoking and Substance Involvement Screening Test. Statistical analysis was developed using the software SPSS. The highest prevalence rates in the past three months were found in the male subsample for use of tobacco (56.4%), alcoholic drinks (75.8%), cannabis (16.9%), and cocaine/crack (10.1%). Religion and educational level appear as an important protective factor against the use of drugs. A prevalence of consumption of psychoactive substances among the users of this area within the scope of work of nurses was evidenced.

Alcohol and substance screening and brief intervention for detainees kept in police custody. A feasibility study

BACKGROUND

Screening and brief intervention programs related to addictive disorders have proven effective in a variety of environments. Both the feasibility and outcome of brief interventions performed in police custody by forensic physicians are unknown. Our objectives were to characterize addictive behaviors in detainees and to evaluate the feasibility of a brief intervention at the time of the medical examination in police custody.

METHODS

This prospective study included 1000 detainees in police custody who were examined by a physician for the assessment of fitness for detention. We used a standardized questionnaire and collected data concerning individual characteristics, addictive disorders, and reported assaults or observed injuries.

RESULTS

944 men and 56 women (94-6%) were studied. We found an addictive disorder in 708 of 1000 cases (71%), with the use of tobacco (62%), alcohol (36%), cannabis (35%), opiates (5%), and cocaine (4%) being the most common. A brief intervention was performed in 544 of these 708 cases (77%). A total of 139 of the 708 individuals (20%) expressed a willingness to change and 14 of 708 (2%) requested some information on treatment options. The main reasons why brief interventions were not performed were aggressive behaviors, drowsiness, or fanciful statements by the detainee.

CONCLUSION

Brief interventions and screening for addictive behaviors in police custody are feasible in the majority of cases. The frequent link between addictive behaviors and the suspected crimes highlights the value of such interventions, which could be incorporated into the public health mission of the physician in police custody.