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Balán IC, Marone RO, Barreda V, Naar S, Wang Y. Integration of an Electronic Screening, Brief Intervention, and Referral to Treatment Program Into an HIV Testing Program to Reduce Substance Use and HIV Risk Behavior Among Men Who Have Sex With Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56683. [PMID: 38483463 PMCID: PMC10979339 DOI: 10.2196/56683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionally affected by HIV and drug and alcohol use; however, few effective HIV prevention interventions for MSM who use substances exist. Screening, Brief Intervention, and Referral to Treatment is an early intervention for non-treatment-seeking individuals with problematic substance use and for timely referral to treatment for those with substance use disorders. Electronic screening and brief interventions (e-SBIs) reduce implementation challenges. An e-SBI tailored for MSM at the time of HIV testing might be particularly opportune to strengthen their motivation to reduce substance use and HIV risk behavior. OBJECTIVE This study aims to develop a tailored e-SBI program to reduce substance use and HIV risk behavior among MSM seeking HIV testing at Nexo Asociación Civil, our community partners in Argentina (primary); assess the feasibility and acceptability of integrating the e-SBI into the Nexo HIV testing program (primary); assess the feasibility and acceptability of implementing an adapted Men's Health Project (MHP) at Nexo (secondary); and finally, explore preliminary findings on substance use and sexual risk reduction outcomes (exploratory). METHODS This mixed methods study has 2 stages. During stage 1 (development), we will use the User Centered Rapid App Design process consisting of focus groups (n=16), individual interviews (n=24), and a pilot deployment of the e-SBI (n=50) to iteratively develop the e-SBI. Quantitative and qualitative assessments at each step will inform the revision of the e-SBI. Furthermore, we will use the assessment, decision, administration, production, topic experts, integration, training, testing framework to adapt MHP. During stage 2 (pilot randomized controlled trial [RCT]), we will randomize 200 MSM coming to Nexo for HIV testing. They will complete a baseline assessment and then their assigned intervention (e-SBI vs screening only) and will be followed-up for 6 months. We will also conduct in-depth interviews with up to 45 participants: 15 participants from either study condition who entered or completed MHP or other substance abuse treatment and 15 from each arm who met the criteria for MHP but did not request it. RESULTS The study began recruitment in October 2022, and the stage-1 pilot study is near completion. Preliminary findings from stage 1 show high e-SBI acceptability. Data analysis of the stage-1 pilot is now beginning. The stage-2 pilot RCT will be launched in March 2024, with all data collection completed by May 2025. CONCLUSIONS This study will allow us to assess the acceptability and feasibility of e-SBI implementation during HIV testing encounters. We will also build the necessary research infrastructure for a subsequent RCT to assess the efficacy of e-SBIs in reducing substance use and HIV sexual risk behavior among MSM in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05542914; https://tinyurl.com/yyjj64dm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56683.
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Affiliation(s)
- Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | | | | | - Sylvie Naar
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Yuxia Wang
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
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Sapru S, Mitchell K, McFadden T. Combining Physician Expertise and Women's Lived Experience to Educate Health Professionals about Preventing Fetal Alcohol Spectrum Disorders. Matern Child Health J 2024; 28:229-239. [PMID: 37847449 DOI: 10.1007/s10995-023-03786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Physician Champions from the American College of Obstetricians and Gynecologists (ACOG) and trained women Speakers from FASD United, who have given birth to a child with a fetal alcohol spectrum disorder (FASD), co-present to healthcare providers (HCPs) in medical residency programs as part of an educational intervention. They present FASDs as a biological and social problem surrounded by stigma that prevent pregnant women from talking openly to their HCPs about their alcohol use or alcohol use disorder (AUD) and getting the medical help they need. METHODS Semi-structured interviews were conducted with 10 ACOG Champions and nine FASD United Speakers and a thematic analysis assessed how the co-presentations can enhance HCPs' understanding about FASDs and address stigma associated with alcohol use during pregnancy. RESULTS Interview findings indicated that both Champions and Speakers emphasized the need for HCPs to be nonjudgmental and create a safe space for open dialogue. They reported that residents were moved by mothers' personal stories, wanted to understand AUD better, and asked about the type of help HCPs can offer women. DISCUSSION Combining physicians' expertise with mothers' personal stories of lived experiences of FASDs directed at residents, who are more reflective and open at this phase of their careers, moved them from a fact-based to an empathy-based approach to learning that is critical to address the stigma surrounding women who may be using alcohol or struggling with an AUD during pregnancy. Collaboration between national organizations allowed this intervention to be widely implemented across the country.
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Affiliation(s)
| | | | - Tonya McFadden
- American College of Obstetricians and Gynecologists, Washington, DC, USA
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Pérula-Jiménez C, Romero-Rodríguez E, Fernández-Solana J, Fernández-García JÁ, Parras-Rejano JM, Pérula-de Torres LÁ, González-de la Rubia A, González-Santos J. Primary Care Professionals' Empathy and Its Relationship to Approaching Patients with Risky Alcohol Consumption. Healthcare (Basel) 2024; 12:262. [PMID: 38275543 PMCID: PMC10815215 DOI: 10.3390/healthcare12020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center's scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.
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Affiliation(s)
- Celia Pérula-Jiménez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Montoro Health Center, Andalusian Health Service, 14600 Cordoba, Spain
| | - Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Cordoba and Guadalquivir Health District, 14001 Cordoba, Spain;
| | | | - José Ángel Fernández-García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Villarrubia Center, 14005 Cordoba, Spain
| | - Juan Manuel Parras-Rejano
- Cordoba and Guadalquivir Health District, 14001 Cordoba, Spain;
- Huerta de la Reina Health Center, Andalusian Health Service, 14600 Cordoba, Spain
| | - Luis Ángel Pérula-de Torres
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPS-ISCIII), 08007 Zaragoza, Spain;
- Program of Preventive Activities and Health Promotion (PAPPS-semFYC), 08009 Barcelona, Spain
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Solovei A, Mercken L, Jané-Llopis E, Bustamante I, Evers S, Gual A, Medina P, Mejía-Trujillo J, Natera-Rey G, O’Donnell A, Pérez-Gómez A, Piazza M, de Vries H, Anderson P. Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol. Health Promot Int 2023; 38:daab192. [PMID: 34849866 PMCID: PMC10439512 DOI: 10.1093/heapro/daab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Antoni Gual
- Addictions Unit. Psychiatry Dept. Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos. Instituto Carlos III, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Zhai J, Wang W, Zhang L, Fu R, Zeng Q, Huang L, Zhao M, Du J. The Effect of SBIRT on Harmful Alcohol Consumption in the Community Health Centers of Shanghai, China: A Randomized Controlled Study. Alcohol Alcohol 2022; 57:742-748. [PMID: 35945705 DOI: 10.1093/alcalc/agac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The present study was a randomized controlled trial with a longitudinal design aimed at examining the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) on harmful alcohol use in the community health centres in Shanghai, China, and further compared the effects of a multi-session brief intervention (MBI) and a single-session brief intervention (SBI). METHODS A total of 362 participants were recruited from four districts of Shanghai and randomly assigned to MBI, SBI and routine care (RC) groups. The MBI group received the brief intervention twice. Follow-up assessments were conducted at 1 and 3 months after the intervention. RESULTS Compared with the SBI and the RC groups, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores (F = 6.422, P = 0.002), SDS scores (F = 5.779, P = 0.003) and SAS scores (F = 4.004, P = 0.019) were significant improved in the MBI group at 1and 3-month follow-up assessment. In the SBI group, the SDS scores decreased significantly compared with the RC group, and there were no significant differences in ASSIST scores, drinking knowledge scores and SAS scores 1-month follow-up assessment. CONCLUSION The findings suggested that SBIRT with two sessions of BI had considerable effects on individuals with harmful alcohol use. It provided clinical evidence for future use in China and other Asian countries with similar situations.
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Affiliation(s)
- Jing Zhai
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Wenzheng Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Rao Fu
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Qingzhi Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Leping Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China.,Shanghai Key Laboratory of Psychotic Disorders; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, 319 Yueyang Road, Shanghai, Prc, 200031, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, 600 Wanping Nan Road, Shanghai, Prc, 200030, China
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Karlsson N, Skagerström J, O'Donnell A, Abidi L, Thomas K, Nilsen P, Lid TG. Public perceptions of how alcohol consumption is dealt with in Swedish and Norwegian health care. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:243-255. [PMID: 35310609 PMCID: PMC8899254 DOI: 10.1177/1455072520985981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Aims: The aims of this study were to evaluate and compare popular beliefs and attitudes regarding alcohol conversations in healthcare in Sweden and Norway; and to explore which factors were associated with different levels of support for alcohol-prevention work in the two countries. Methods: Population-based cross-sectional surveys were conducted in Sweden (n = 3000) and Norway (n = 1208). Logistic regression was used to identify the characteristics of participants who were supportive of routine alcohol screening and brief intervention delivery. Results: A higher proportion of Swedish respondents agreed to a large extent that healthcare professionals should routinely ask about alcohol consumption. In addition, a higher proportion of Swedish respondents compared to respondents from Norway agreed that healthcare providers should only ask about patient’s alcohol consumption if this was related to specific symptoms. There were similar correlates of being supportive of routine alcohol screening and brief intervention delivery in both countries. Support was lower in both countries amongst moderate and risky drinkers, and among single adults or those on parental leave, but higher amongst older individuals. Having had an alcohol conversation in healthcare increased the level of support for alcohol prevention in routine healthcare among risky drinkers. Conclusions: There is a high level of support for preventative alcohol conversations in routine healthcare in Norway and Sweden, although there was a lower proportion of respondents who were positive to alcohol prevention in routine healthcare in Norway compared to Sweden. Experiencing alcohol conversation may positively affect risky drinkers’ attitudes towards and support for alcohol prevention. Thus, more frequent alcohol conversations in routine healthcare may also result in increased level of support for alcohol prevention among risky drinkers.
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Affiliation(s)
| | - Janna Skagerström
- Linköping University, Sweden; and Research and Development Unit in Region Östergötland, Linköping, Sweden
| | | | | | | | | | - Torgeir Gilje Lid
- Stavanger University Hospital, Norway; and University of Stavanger, Norway
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Solovei A, Jané-Llopis E, Mercken L, Bustamante I, Kokole D, Mejía-Trujillo J, Medina Aguilar PS, Natera Rey G, O'Donnell A, Piazza M, Schmidt CS, Anderson P, de Vries H. Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:224-236. [PMID: 35032246 PMCID: PMC8760585 DOI: 10.1007/s11121-021-01329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/25/2022]
Abstract
Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Univ. Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Department of Health Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Potthoff S, O'Donnell AJ, Karlsen AT, Brendryen H, Lid TG. Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention. FRONTIERS IN HEALTH SERVICES 2022; 2:940383. [PMID: 36925895 PMCID: PMC10012791 DOI: 10.3389/frhs.2022.940383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Introduction Alcohol consumption is a leading global risk factor for ill-health and premature death. Alcohol screening and brief interventions (SBI) delivered in primary care is effective at reducing alcohol consumption, but routine implementation remains problematic. Screening all patients for excessive drinking (universal screening) is resource-intensive and may be at odds with general practitioners' (GPs') perceived professional role. This study aimed to develop a tailored, theory-based training intervention to strengthen GPs' ability to address alcohol and to manage alcohol-related health problems through a pragmatic approach based on clinical relevance. Methods A qualitative study design involving focus group interviews and a structured questionnaire for free text replies with GPs in Norway. Behavioral analysis assessed factors influencing delivery of SBI according to the 'capability, opportunity, motivation and behavior' (COM-B) model to inform intervention development using the Behavior Change Wheel. Qualitative data were analyzed using framework analysis and an iterative approach was adopted to develop the training. Results A purposive sample of GPs attended the focus groups (n = 25) and completed the questionnaire (n = 55). Four areas required additional support including: understanding the link between alcohol use and health problems; opening up the conversation on alcohol use; addressing alcohol and dealing with obstacles; and following-up and maintaining change. Findings informed the development of a four-session interactive training intervention and a digital intervention for providing support for patients between consultations to address the identified needs. Conclusion This work highlights the value of pragmatic, relevance-based clinical strategies, as opposed to universal screening approaches to addressing alcohol in primary care. A pragmatic approach is more in line with GPs existing sclinical skill set and holds the potential to improve widespread uptake and implementation of SBI in routine primary care.
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Affiliation(s)
- Sebastian Potthoff
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Amy Jane O'Donnell
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Håvar Brendryen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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McNeely J, Mazumdar M, Appleton N, Bunting AM, Polyn A, Floyd S, Sharma A, Shelley D, Cleland CM. Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT). Subst Abus 2022; 43:564-572. [PMID: 34586976 PMCID: PMC9968463 DOI: 10.1080/08897077.2021.1975868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda M. Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonia Polyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Floyd
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Akarsh Sharma
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University Global School of Public Health
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Abstract
Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.
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Affiliation(s)
- Jennifer McNeely
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine, New York, NY 10016, USA.
| | - Leah Hamilton
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA
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11
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Sivertsen DM, Becker U, Andersen O, Kirk JW. An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department. Addict Sci Clin Pract 2021; 16:60. [PMID: 34600564 PMCID: PMC8487327 DOI: 10.1186/s13722-021-00269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. Methods An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. Results 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”. Conclusions Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00269-z.
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Affiliation(s)
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
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12
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Fankhänel T, Panic BJ, Schwarz M, Schulz K, Frese T. Treating Excessive Consumers With Brief Intervention to Reduce Their Alcohol Consumption. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: General Practitioners’ (GP) readiness to implement screening and brief intervention to reduce alcohol consumption of excessive consumers is low. Although several barriers were identified by past research, improving these conditions has not led to improved implementation. Based on Expectancy Value Theory of Achievement Motivation we assume that low seriousness of the health problem in association with the treatment of excessive alcohol consumers may be considered as a crucial barrier too. Aims: By our study, we tested for the influence of the seriousness of the health problem on the GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence. Method: In order to manipulate the seriousness of the health problem GPs were confronted with three different situations each introducing a fictitious patient with either excessive alcohol consumption, or binge drinking, or harmful alcohol consumption. Results: Questionnaires of 185 GPs were analyzed. As hypothesized GPs were less ready to treat patients with excessive consumption in comparison to patients with harmful consumption, t(184) = 5.51, p < .001, d = .40, and binge drinking, t(184) = 6.14, p < .001, d = .43. Their readiness was higher in case of high adherence, F(1, 181) = 17.35, p < .001, η2 = .09. Limitations: Recruitment of GPs was based on voluntary participation. GPs had to assess their readiness in the artificial context of case vignettes. Conclusion: GPs’ readiness to implement a BI was influenced by the seriousness of the health problem and expected patient adherence. No such effect was found for financial reimbursement.
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Affiliation(s)
- Thomas Fankhänel
- Institute for General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Benjamin Jovan Panic
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Marcus Schwarz
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Katrin Schulz
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Thomas Frese
- Institute for General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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13
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McNeely J, Adam A, Rotrosen J, Wakeman SE, Wilens TE, Kannry J, Rosenthal RN, Wahle A, Pitts S, Farkas S, Rosa C, Peccoralo L, Waite E, Vega A, Kent J, Craven CK, Kaminski TA, Firmin E, Isenberg B, Harris M, Kushniruk A, Hamilton L. Comparison of Methods for Alcohol and Drug Screening in Primary Care Clinics. JAMA Netw Open 2021; 4:e2110721. [PMID: 34014326 PMCID: PMC8138691 DOI: 10.1001/jamanetworkopen.2021.10721] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Guidelines recommend that adult patients receive screening for alcohol and drug use during primary care visits, but the adoption of screening in routine practice remains low. Clinics frequently struggle to choose a screening approach that is best suited to their resources, workflows, and patient populations. OBJECTIVE To evaluate how to best implement electronic health record (EHR)-integrated screening for substance use by comparing commonly used screening methods and examining their association with implementation outcomes. DESIGN, SETTING, AND PARTICIPANTS This article presents the outcomes of phases 3 and 4 of a 4-phase quality improvement, implementation feasibility study in which researchers worked with stakeholders at 6 primary care clinics in 2 large urban academic health care systems to define and implement their optimal screening approach. Site A was located in New York City and comprised 2 clinics, and site B was located in Boston, Massachusetts, and comprised 4 clinics. Clinics initiated screening between January 2017 and October 2018, and 93 114 patients were eligible for screening for alcohol and drug use. Data used in the analysis were collected between January 2017 and October 2019, and analysis was performed from July 13, 2018, to March 23, 2021. INTERVENTIONS Clinics integrated validated screening questions and a brief counseling script into the EHR, with implementation supported by the use of clinical champions (ie, clinicians who advocate for change, motivate others, and use their expertise to facilitate the adoption of an intervention) and the training of clinic staff. Clinics varied in their screening approaches, including the type of visit targeted for screening (any visit vs annual examinations only), the mode of administration (staff-administered vs self-administered by the patient), and the extent to which they used practice facilitation and EHR usability testing. MAIN OUTCOMES AND MEASURES Data from the EHRs were extracted quarterly for 12 months to measure implementation outcomes. The primary outcome was screening rate for alcohol and drug use. Secondary outcomes were the prevalence of unhealthy alcohol and drug use detected via screening, and clinician adoption of a brief counseling script. RESULTS Patients of the 6 clinics had a mean (SD) age ranging from 48.9 (17.3) years at clinic B2 to 59.1 (16.7) years at clinic B3, were predominantly female (52.4% at clinic A1 to 64.6% at clinic A2), and were English speaking. Racial diversity varied by location. Of the 93,114 patients with primary care visits, 71.8% received screening for alcohol use, and 70.5% received screening for drug use. Screening at any visit (implemented at site A) in comparison with screening at annual examinations only (implemented at site B) was associated with higher screening rates for alcohol use (90.3%-94.7% vs 24.2%-72.0%, respectively) and drug use (89.6%-93.9% vs 24.6%-69.8%). The 5 clinics that used a self-administered screening approach had a higher detection rate for moderate- to high-risk alcohol use (14.7%-36.6%) compared with the 1 clinic that used a staff-administered screening approach (1.6%). The detection of moderate- to high-risk drug use was low across all clinics (0.5%-1.0%). Clinics with more robust practice facilitation and EHR usability testing had somewhat greater adoption of the counseling script for patients with moderate-high risk alcohol or drug use (1.4%-12.5% vs 0.1%-1.1%). CONCLUSIONS AND RELEVANCE In this quality improvement study, EHR-integrated screening was feasible to implement in all clinics and unhealthy alcohol use was detected more frequently when self-administered screening was used at any primary care visit. The detection of drug use was low at all clinics, as was clinician adoption of counseling. These findings can be used to inform the decision-making of health care systems that are seeking to implement screening for substance use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02963948.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Medicine, Division of General Internal Medicine, New York University Grossman School of Medicine, New York
| | - Angéline Adam
- Department of Psychiatry, University Hospital Lausanne, Lausanne, Switzerland
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Sarah E. Wakeman
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston
| | | | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Sarah Farkas
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carmen Rosa
- National Institute on Drug Abuse, Bethesda, Maryland
| | - Lauren Peccoralo
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eva Waite
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aida Vega
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Kent
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine K. Craven
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Elizabeth Firmin
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | | | - Melanie Harris
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Andre Kushniruk
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Leah Hamilton
- Department of Population Health, New York University Grossman School of Medicine, New York
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14
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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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15
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Torres VN, Williams EC, Ceballos RM, Donovan DM, Duran B, Ornelas IJ. Participant engagement in a community based participatory research study to reduce alcohol use among Latino immigrant men. HEALTH EDUCATION RESEARCH 2020; 35:627-636. [PMID: 33025021 PMCID: PMC7768666 DOI: 10.1093/her/cyaa039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Although Latino immigrant men experience many health disparities, they are underrepresented in research to understand and address disparities. Community Based Participatory Research (CBPR) has been identified to encourage participant engagement and increase representation in health disparities research. The CBPR conceptual model describes how partnership processes and study design impact participant engagement in research. Using this model, we sought to describe how these domains influenced participant engagement in a pilot randomized controlled trial of brief intervention for unhealthy alcohol use (n = 121) among Latino immigrant men. We conducted interviews with a sample of study participants (n = 25) and reviewed logs maintained by 'promotores'. We identified facilitators of participant engagement, including the relevance of the study topic, alignment with participants' goals to improve their lives, partnerships with study staff that treated participants respectfully and offered access to resources. Further, men reported that the study time and location were convenient and that they appreciated being compensated for their time. Barriers to participant engagement included survey questions that were difficult to understand and competing demands of work responsibilities. Findings suggest that engaging underserved communities requires culturally responsive and community engagement strategies that promote trust. Future studies should further investigate how CBPR partnership processes can inform intervention research.
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Affiliation(s)
- Vanessa N Torres
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA), Puget Sound Health Care System, Seattle, WA, USA
| | - Rachel M Ceballos
- Department of Health Services, University of Washington, Seattle, WA, USA
- Fred Hutchison Cancer Research Center, Seattle, WA, USA
| | - Dennis M Donovan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Alcohol and Drug Abuse Institute (ADAI), Seattle, WA, USA
| | - Bonnie Duran
- School of Social Work, University of Washington, Seattle, WA, USA
| | - India J Ornelas
- Department of Health Services, University of Washington, Seattle, WA, USA
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16
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Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res 2020; 44:2386-2400. [PMID: 33119905 DOI: 10.1111/acer.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.
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Affiliation(s)
- Kristine Lou Gargaritano
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caoimhe Murphy
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Austin B Auyeung
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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17
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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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18
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Khadjesari Z, Stevenson F, Toner P, Linke S, Milward J, Murray E. 'I'm not a real boozer': a qualitative study of primary care patients' views on drinking and its consequences. J Public Health (Oxf) 2020; 41:e185-e191. [PMID: 29912419 DOI: 10.1093/pubmed/fdy067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The public health message around alcohol is complex, with benefits versus harms, the confusing concept of risk and drinking guidance changing over time. This provides a difficult context for alcohol screening in primary care, with established barriers from the practitioner perspective, but less is known about the patients' perspective. This study explores patients' views on drinking. METHODS Eligible participants were recorded as drinking above low risk levels in primary care. Six practices in North London participated. Interviews were in-depth, semi-structured, transcribed verbatim and underwent detailed thematic analysis. FINDINGS Interviews were conducted with 8 women and 12 men, aged 26-83 years, mostly educated to undergraduate level and of 'White' ethnicity. UK drinking guidance was viewed as irrelevant for reasons related to life stage, lifestyle and absence of harm. Dependence, loss of functionality and control were perceived as key features of problematic drinking. Healthy lifestyles, in terms of diet, exercise and not smoking, were thought to mitigate potential problems associated with alcohol intake. CONCLUSION The findings suggest that public health messages and brief advice should focus on harm experienced at different life stages, among people with different lifestyles, to challenge the ubiquitous view that 'I'm not a real boozer'.
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Affiliation(s)
- Z Khadjesari
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, 16 De Crespigny Park, Camberwell, London, UK
| | - F Stevenson
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
| | - P Toner
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK
| | - S Linke
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Camden and Islington Mental Health Trust, 4 St Pancras Way, Kings Cross, London, UK
| | - J Milward
- Addictions Department, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, UK
| | - E Murray
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
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19
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Stuppe M, Bischof G. Hindernisse und Risiken bei der Implementierung einer
Kurzintervention nach Screening alkoholbezogener Störungen mittels AUDIT
in der Unfallchirurgie. SUCHTTHERAPIE 2019. [DOI: 10.1055/a-1063-1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungAuf einer unfallchirurgischen Station wurde über 3 Monate ein
modifizierter AUDIT eingesetzt, um alle neu aufgenommenen Patienten mit
alkoholbezogenen Störungen zu identifizieren und nach einer
Kurzintervention dem suchtspezifischen Behandlungssystem zuführen zu
können. 361 Patienten bekamen den Fragebogen in den ersten
Behandlungstagen ausgehändigt und erhielten bei einem
auffälligen Screeningergebnis das Angebot zu einem Gespräch. Mit
diesem Verfahren wurde in einem naturalistischen Setting jedoch kein Patient mit
einer schweren alkoholbezogenen Störung erreicht. Eine reduzierte
Inanspruchnahme des zuvor üblichen Konsilverfahrens und die
möglicherweise gesenkte Diagnosestellung durch die behandelnden
Ärzte deuteten sogar auf das potentielle Risiko einer Verschlechterung
der Versorgung hin. Implementierungskräfte müssen beachtet
werden.
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Affiliation(s)
- Markus Stuppe
- Klinik für Abhängigkeitserkrankungen,
Carl-Friedrich-Flemming-Klinik, Helios Kliniken Schwerin
| | - Gallus Bischof
- Klinik für Psychiatrie und Psychotherapie des
Universitätsklinikums Schleswig-Holstein, Universität zu
Lübeck
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20
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Becan JE, Crawley RD, Knight DK. Using a Train-the-Trainer Model to Promote Practice Change among Agencies Serving Justice-Involved Youth. FEDERAL PROBATION 2019; 83:47-53. [PMID: 35095111 PMCID: PMC8794422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Danica K Knight
- Institute of Behavioral Research, Texas Christian University
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21
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Ornelas IJ, Doyle SR, Torres VN, Serrano SE, Duran B, Donovan DM. Vida PURA: results from a pilot randomized trial of a culturally adapted screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers. Transl Behav Med 2019; 9:1233-1243. [PMID: 31206579 PMCID: PMC6875653 DOI: 10.1093/tbm/ibz071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Latino immigrant men are at increased risk for unhealthy alcohol use. Vida PURA is a culturally adapted evidence-based intervention that consists of promotores providing screening and brief intervention to reduce unhealthy alcohol use among Latino immigrant men. The purpose was to assess the efficacy of Vida PURA in a pilot randomized control trial. Participants were screened for eligibility at a day labor worker center using the Alcohol Use Disorders Identification Test (AUDIT). Those with an AUDIT score ≥ 6 (N = 121) were randomized into an intervention (N = 77) or control group (N = 44). Participants in the intervention group received a brief intervention from a promotor including personalized feedback, motivational interviewing to assess their readiness to change, and referral to services. Participants in the control group received information about local substance use treatment services. We assessed changes in AUDIT scores, drinks per drinking day, drinking days, and frequency of heavy episodic drinking at 2 and 8 weeks following the baseline survey using a mixed-effects regression model. Many men had high AUDIT scores, indicating dependence. Both the intervention and control groups reduced their alcohol-related behaviors over time, but there were no significant differences between the groups. A culturally adapted brief intervention may not be enough to significantly reduce alcohol use among Latino day laborers, especially among those that are dependent. We discuss lessons learned from this trial, including the value of community-based approaches to reaching high-risk and underserved populations.
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Affiliation(s)
- India J Ornelas
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Suzanne R Doyle
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Vanessa N Torres
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Samantha E Serrano
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Bonnie Duran
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Dennis M Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
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Adam A, Schwartz RP, Wu LT, Subramaniam G, Laska E, Sharma G, Mili S, McNeely J. Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool. Addict Sci Clin Pract 2019; 14:39. [PMID: 31615549 PMCID: PMC6794766 DOI: 10.1186/s13722-019-0167-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/27/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The TAPS Tool is a substance use screening and brief assessment instrument that was developed for use in primary care medical settings. It is one of the first screening instruments to provide rapid assessment of all commonly used substance classes, including illicit and prescription opioids, and is one of the only available screeners designed and validated in an electronic self-administered format (myTAPS). This secondary analysis of data from the TAPS Tool validation study describes the feasibility and acceptability of the myTAPS among primary care patients. METHODS Adult patients (N = 2000) from five primary care clinics completed the TAPS Tool on a tablet computer (myTAPS), and in an interviewer-administered format. Requests for assistance and time required were tracked, and participants completed a survey on ease of use, utilization of audio guidance, and format preference. Logistic regression was used to examine outcomes in defined subpopulations, including groups that may have greater difficulty completing an electronic screener, and those that may prefer an electronic self-administered approach. RESULTS Almost all participants (98.3%) reported that the myTAPS was easy to use. The median time to complete myTAPS screening was 4.0 min (mean 4.48, standard deviation 2.57). More time was required by participants who were older, Hispanic, Black, or reported non-medical prescription drug use, while less time was required by women. Assistance was requested by 25% of participants, and was more frequently requested by those who with lower education (OR = 2.08, 95% CI 1.62-2.67) or age > 65 years (OR = 2.79, 95% CI 1.98-3.93). Audio guidance was utilized by 18.3%, and was more frequently utilized by participants with lower education (OR = 2.01, 95% CI 1.54-2.63), age > 65 years (OR = 1.79, 95% CI 1.22-2.61), or Black race (OR = 1.30, 95% 1.01-1.68). The myTAPS format was preferred by women (OR = 1.29, 95% CI 1.00-1.66) and individuals with drug use (OR = 1.43, 95% CI 1.09-1.88), while participants with lower education preferred the interviewer-administered format (OR = 2.75, 95% CI 2.00-3.78). CONCLUSIONS Overall, myTAPS screening was feasible and well accepted by adult primary care patients. Clinics adopting electronic screening should be prepared to offer assistance to some patients, particularly those who are older or less educated, and should have the capacity to use an interviewer-administered approach when required.
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Affiliation(s)
- Angéline Adam
- Department of Population Health, New York University (NYU) School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA.
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Inc, Baltimore, MD, 21201, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710, USA
| | - Geetha Subramaniam
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD, 20892, USA
| | - Eugene Laska
- Department of Psychiatry, NYU Langone School of Medicine, New York, NY, 10016, USA
| | - Gaurav Sharma
- The EMMES Corporation, 401 North Washington Street, Rockville, MD, 20850, USA
| | - Saima Mili
- Department of Population Health, New York University (NYU) School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
| | - Jennifer McNeely
- Department of Population Health, New York University (NYU) School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
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McNeely J, Haley SJ, Smith AJ, Leonard NR, Cleland CM, Ferdschneider M, Calderoni M, Sleiter L, Ciotoli C, Adam A. Computer self-administered screening for substance use in university student health centers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:541-550. [PMID: 30240331 PMCID: PMC6428636 DOI: 10.1080/07448481.2018.1498852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/11/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: To characterize the prevalence of tobacco, alcohol, and drug use and the acceptability of screening in university health centers. Participants: Five hundred and two consecutively recruited students presenting for primary care visits in February and August, 2015, in two health centers. Methods: Participants completed anonymous substance use questionnaires in the waiting area, and had the option of sharing results with their medical provider. We examined screening rates, prevalence, and predictors of sharing results. Results: Past-year use was 31.5% for tobacco, 67.1% for alcohol (>4 drinks/day), 38.6% for illicit drugs, and 9.2% for prescription drugs (nonmedical use). A minority (43.8%) shared screening results. Sharing was lowest among those with moderate-high risk use of tobacco (OR =0.37, 95% CI 0.20-0.69), alcohol (OR =0.48, 95% CI 0.25-0.90), or illicit drugs (OR =0.38, 95% CI 0.20-0.73). Conclusions: Screening can be integrated into university health services, but students with active substance use may be uncomfortable discussing it with medical providers.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, NYU School of Medicine, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine, NYU School of Medicine, New York, New York, USA
| | - Sean J. Haley
- Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Allison J. Smith
- Student Health Center, New York University, New York, New York, USA
| | - Noelle R. Leonard
- Center on Drug Use and HIV Research and NYU College of Nursing, New York University, New York, New York, USA
| | - Charles M. Cleland
- Center on Drug Use and HIV Research and NYU College of Nursing, New York University, New York, New York, USA
| | | | | | - Luke Sleiter
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Carlo Ciotoli
- Student Health Center, New York University, New York, New York, USA
| | - Angéline Adam
- Department of Population Health, NYU School of Medicine, New York, New York, USA
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O'Grady MA, Kapoor S, Kwon N, Morley J, Auerbach M, Neighbors CJ, Conigliaro J, Morgenstern J. Substance use screening and brief intervention: Evaluation of patient and implementation differences between primary care and emergency department settings. J Eval Clin Pract 2019; 25:441-447. [PMID: 30426596 DOI: 10.1111/jep.13060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/06/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency. METHODS Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567). Patients with a positive screen were further assessed for psychosocial, health, and substance use problems (n = 1604). Differences in patient characteristics between primary care and emergency settings were examined using chi-square and t tests. Multilevel logistic regression was used to examine whether setting type predicted screening results. Site-level indicators of implementation success were calculated (percentage prescreens completed, percentage full screens completed, and percentage refused services) for all patient visits (n = 78 656). RESULTS As compared with primary care patients, emergency patients had more severe substance use patterns and screening scores, were more likely to use a variety of illicit drugs, and reported more psychosocial issues. In logistic regression models, setting type did not predict whether patients screened positive; however, it did predict screening into a higher vs lower risk category such that emergency patients were more likely to be in a higher risk category. Emergency settings had lower indicators of implementation success (eg, 14% lower prescreen completion rate) as compared with primary care settings on some implementation measures. CONCLUSIONS This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care.
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Affiliation(s)
- Megan A O'Grady
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA
| | - Sandeep Kapoor
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Nancy Kwon
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Jeanne Morley
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Mark Auerbach
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Charles J Neighbors
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA
| | - Joseph Conigliaro
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Jon Morgenstern
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA.,Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
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Romero-Rodríguez E, Pérula de Torres LÁ, Leiva-Cepas F, Fernández García JÁ, Fernández López S, Martín-Rabadán Muro M, Camarelles Guillem F, Roldán Villalobos A. Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study. PLoS One 2019; 14:e0216199. [PMID: 31083659 PMCID: PMC6513087 DOI: 10.1371/journal.pone.0216199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/16/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Primary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals' level of training and attitude are crucial in the clinical practice regarding alcohol use. OBJECTIVE To evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use. DESIGN An observational, descriptive, cross-sectional, multi-center study. METHODOLOGY Location: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05). RESULTS Participants: 1,760 healthcare providers completed the survey (75.6% [95% CI 73.5-77.6] family physicians; 11.4% [95% CI 9.9-12.9] medical residents; and 12.5% [95% CI 10.9-14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26-64, 95% CI: 47.2-48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p <0.001), female (p = 0.010), between 46 and 55 years old (p <0.001). CONCLUSIONS PC providers' knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Luis Ángel Pérula de Torres
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain
- Preventive Activities and Health Promotion Program -PAPPS- (semFYC), Barcelona, Spain
- PAPPS Evaluation and Improvement Group (semFYC), Barcelona, Spain
| | - Fernando Leiva-Cepas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- USBA Cerro Muriano. Brigada Guzmán ¨El bueno¨ X. Ministry of Defence, Cordoba, Spain
| | - José Ángel Fernández García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Villarrubia Health Center, Andalusian Health Service, Cordoba, Spain
| | | | | | - Francisco Camarelles Guillem
- Preventive Activities and Health Promotion Program -PAPPS- (semFYC), Barcelona, Spain
- Infanta Mercedes Health Center, Madrid, Spain
| | - Ana Roldán Villalobos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain
- Carlos Castilla del Pino Health Center, Andalusian Health Service, Cordoba, Spain
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Klimas J, Fairgrieve C, Tobin H, Field C, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018; 12:CD009269. [PMID: 30521696 PMCID: PMC6517179 DOI: 10.1002/14651858.cd009269.pub4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. OBJECTIVES To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. AUTHORS' CONCLUSIONS We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
- School of Medicine, University College DublinHealth Science Centre, Belfield, UCDDublinIrelandD4
| | - Christopher Fairgrieve
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
| | - Helen Tobin
- University College DublinSchool of MedicineDublinIreland
| | - Catherine‐Anne Field
- National University of Ireland GalwayCollege of Medicine, Nursing, & Health Sciences, School of Health SciencesGalwayIreland
| | - Clodagh SM O'Gorman
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Graduate Entry Medical School, University of LimerickDepartment of PaediatricsLimerickIreland
| | - Liam G Glynn
- Graduate Entry Medical School, University of LimerickGeneral PracticeLimerickIreland
| | - Eamon Keenan
- Health Service ExecutiveAddiction ServicesBridge House, Cherry Orchard HospitalBallyfermotDublinIreland10
| | - Jean Saunders
- Graduate Entry Medical School, University of LimerickStatistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTARLimerickIreland
| | - Gerard Bury
- University College DublinSchool of MedicineDublinIreland
| | - Colum Dunne
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Faculty of Education and Health Sciences, University of LimerickCentre for Interventions in Infection, Inflammation & Immunity (4i)LimerickIreland
| | - Walter Cullen
- University College DublinSchool of MedicineDublinIreland
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Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry 2018; 31:324-332. [PMID: 29846264 DOI: 10.1097/yco.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field. RECENT FINDINGS Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included. SUMMARY Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.
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Bevelander KE, Herte K, Kakoulakis C, Sanguino I, Tebbe AL, Tünte MR. Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women's Eating Behavior. Front Psychol 2018; 9:658. [PMID: 29867640 PMCID: PMC5952269 DOI: 10.3389/fpsyg.2018.00658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/16/2018] [Indexed: 01/01/2023] Open
Abstract
The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people's eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women's susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project's findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.
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Affiliation(s)
- Kirsten E. Bevelander
- Communication Science, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Katharina Herte
- Department of Social, Health and Organisational Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Inés Sanguino
- Department of Psychology, King’s College London, London, United Kingdom
| | - Anna-Lena Tebbe
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Markus R. Tünte
- Faculty of Psychology, University of Vienna, Vienna, Austria
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McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, Kannry JL, Vega A, Waite EA, Peccoralo LA, Rosenthal RN, McCarty D, Rotrosen J. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addict Sci Clin Pract 2018; 13:8. [PMID: 29628018 PMCID: PMC5890352 DOI: 10.1186/s13722-018-0110-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background
Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006). Results Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial.
Conclusions Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. Electronic supplementary material The online version of this article (10.1186/s13722-018-0110-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA. .,Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Pritika C Kumar
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Traci Rieckmann
- Greenfield Health and Department of Psychiatry, Oregon Health and Science University, 9450 SW Barnes Suite 100, Portland, OR, 97225, USA
| | - Erica Sedlander
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Christine Chollak
- Department of Population Health, New York University School of Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY, 10016, USA
| | - Joseph L Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Aida Vega
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Eva A Waite
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lauren A Peccoralo
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mt. Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Richard N Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, 1090 Amsterdam Avenue, New York, NY, 10025, USA
| | - Dennis McCarty
- OHSU-PSU School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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Johnson NA, Kypri K, Latter J, Dunlop A, Brown A, Saitz R, Saunders JB, Attia J, Wolfenden L, Doran C, McCambridge J. Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews. Drug Alcohol Depend 2018; 183:253-260. [PMID: 29306817 DOI: 10.1016/j.drugalcdep.2017.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A large proportion of hospital outpatients are alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients' awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD. METHODS This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n = 59), or to referral alone (n = 64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug and Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive. RESULTS Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees' did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP. CONCLUSION Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomized trial does not appear to be feasible.
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Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Kypros Kypri
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Joanna Latter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Amanda Brown
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and the Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, 4006, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, 4000, Australia
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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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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Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2017; 70:714-723.e13. [DOI: 10.1016/j.annemergmed.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/03/2023]
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Rehm J, Barbosa C. The cost-effectiveness of therapies to treat alcohol use disorders. Expert Rev Pharmacoecon Outcomes Res 2017; 18:43-49. [DOI: 10.1080/14737167.2018.1392241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, 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, ON, Canada
| | - C. Barbosa
- Behavioral Health and Criminal Justice Division, RTI International, Chicago, IL, USA
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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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Vendetti J, Gmyrek A, Damon D, Singh M, McRee B, Del Boca F. Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration. Addiction 2017; 112 Suppl 2:23-33. [PMID: 28074571 DOI: 10.1111/add.13652] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/14/2015] [Accepted: 02/04/2016] [Indexed: 11/27/2022]
Abstract
AIMS To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges. DESIGN A mixed-method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation. SETTING Multiple sites within the first seven programs funded in a national demonstration program in the United States. PARTICIPANTS One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed. MEASUREMENTS Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded. FINDINGS Providers rated pre-selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra- and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient 'pre-screen' item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high-volume emergency department and trauma center settings; and implement on-site and telephonic treatment delivery. CONCLUSIONS Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start-up phase focused on comprehensive education and training, and on the development of intra- and inter-organizational communication and collaboration; opinion leader support; and practitioner and host site buy-in.
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Affiliation(s)
- Janice Vendetti
- Department of Community Medicine and Health Care, UConn Health, School of Medicine, Farmington, CT, USA
| | | | - Donna Damon
- Department of Community Medicine and Health Care, UConn Health, School of Medicine, Farmington, CT, USA
| | - Manu Singh
- JBS International, North Bethesda, MD, USA
| | - Bonnie McRee
- Department of Community Medicine and Health Care, UConn Health, School of Medicine, Farmington, CT, USA
| | - Frances Del Boca
- Department of Community Medicine and Health Care, UConn Health, School of Medicine, Farmington, CT, USA
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Sánchez-Solís A, de San Jorge X. Experiencias del personal de enfermería con pacientes hospitalizados por abuso de alcohol. ENFERMERÍA UNIVERSITARIA 2017. [DOI: 10.1016/j.reu.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Herring R, Thom B, Bayley M, Tchilingirian J. Delivering alcohol Identification and Brief Advice (IBA) in housing settings: A step too far or opening doors? DRUGS (ABINGDON, ENGLAND) 2016; 23:365-373. [PMID: 28392633 PMCID: PMC5359775 DOI: 10.1080/09687637.2016.1176992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 10/31/2022]
Abstract
Within the UK, there is a drive to encourage the delivery of alcohol screening (or identification) and brief advice (IBA) in a range of contexts beyond primary care and hospitals where the evidence is strongest. However, the evidence base for effectiveness in non-health contexts is not currently established. This paper considers the case of housing provided by social landlords, drawing on two research studies which were conducted concurrently. One study examined the feasibility of delivering alcohol IBA in housing settings and the other the role of training in delivering IBA in non-health contexts including housing. This paper draws mainly on the qualitative data collected for both studies to examine the appropriateness and feasibility of delivering IBA in a range of social housing settings by the housing workforce. Findings suggest that while it is feasible to deliver IBA in housing settings, there are similar challenges and barriers to those already identified in relation to primary care. These include issues around role inadequacy, role legitimacy and the lack of support to work with people with alcohol problems. Results indicate that the potential may lie in focusing training efforts on specific roles to deliver IBA rather than it being expected of all staff.
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Affiliation(s)
- Rachel Herring
- Drug and Alcohol Research Centre, Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, The Burroughs,
Hendon, London
UK
| | - Betsy Thom
- Drug and Alcohol Research Centre, Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, The Burroughs,
Hendon, London
UK
| | - Mariana Bayley
- Drug and Alcohol Research Centre, Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, The Burroughs,
Hendon, London
UK
| | - Jordan Tchilingirian
- Drug and Alcohol Research Centre, Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, The Burroughs,
Hendon, London
UK
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Thom B, Herring R, Bayley M. The role of training in IBA implementation beyond primary health care settings in the UK. DRUGS (ABINGDON, ENGLAND) 2016; 23:374-381. [PMID: 28018054 PMCID: PMC5152544 DOI: 10.1080/09687637.2016.1195792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
There has been a considerable drive to encourage a wide range of professional groups to incorporate alcohol screening (or identification) and brief advice (IBA) into their everyday practice. This article aims to examine the role of training in promoting IBA delivery in contexts outside primary care and other health settings. The data are drawn mainly from a structured online survey supplemented by illustrative material from nine qualitative interviews and insights from an expert workshop. Findings support the results from other research that issues relating to role relevance and role security continue to act as barriers to professional change. Furthermore, issues of organisational commitment and organisational barriers are insufficiently addressed in strategy to promote wider use of IBA. The article concludes that development of appropriate training for alcohol IBA needs to take account of the role of IBA within a complex interactive system of related services and help seeking pathways and consider how training can contribute to changing both professional attitudes and behaviours and organisational approaches to implementing and sustaining IBA in everyday professional practice.
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Affiliation(s)
- Betsy Thom
- Drug and Alcohol Research Centre, Middlesex University, The Burroughs,
Hendon,
London,
UK
| | - Rachel Herring
- Drug and Alcohol Research Centre, Middlesex University, The Burroughs,
Hendon,
London,
UK
| | - Mariana Bayley
- Drug and Alcohol Research Centre, Middlesex University, The Burroughs,
Hendon,
London,
UK
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Platt L, Melendez-Torres GJ, O'Donnell A, Bradley J, Newbury-Birch D, Kaner E, Ashton C. How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis. BMJ Open 2016; 6:e011473. [PMID: 27515753 PMCID: PMC4985973 DOI: 10.1136/bmjopen-2016-011473] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention. METHODS We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check. RESULTS 52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=-0.23, 95% CI (-0.33 to -0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=-0.20, 95% CI (-0.30 to -0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time. CONCLUSIONS ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.
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Affiliation(s)
- Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - G J Melendez-Torres
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Jennifer Bradley
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Charlotte Ashton
- Camden & Islington Public Health, London Boroughs of Islington and Camden, London, UK
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Svanström R, Andersson S, Rosén H, Berglund M. Moving from theory to practice: experience of implementing a learning supporting model designed to increase patient involvement and autonomy in care. BMC Res Notes 2016; 9:361. [PMID: 27448568 PMCID: PMC4958284 DOI: 10.1186/s13104-016-2165-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings. RESULTS At the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants' approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants' experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients. CONCLUSIONS Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.
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Affiliation(s)
- Rune Svanström
- School of Health and Education, University of Skövde, 54128, Skövde, Sweden.
| | - Susanne Andersson
- School of Health and Education, University of Skövde, 54128, Skövde, Sweden
| | - Helena Rosén
- Health Sciences, University of Lund, Lund, Sweden
| | - Mia Berglund
- School of Health and Education, University of Skövde, 54128, Skövde, Sweden
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Bendtsen P, Müssener U, Karlsson N, López-Pelayo H, Palacio-Vieira J, Colom J, Gual A, Reynolds J, Wallace P, Segura L, Anderson P. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial. BMJ Open 2016; 6:e010271. [PMID: 27311902 PMCID: PMC4916585 DOI: 10.1136/bmjopen-2015-010271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. DESIGN The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. SETTING A total of 120 primary healthcare centres from 5 jurisdictions in Europe. PARTICIPANTS 746 individual providers (general practitioners, nurses or other professionals) participated in the study. PRIMARY OUTCOME Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. RESULTS The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. CONCLUSIONS Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. TRIAL REGISTRATION NUMBER NCT01501552; Post-results.
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Affiliation(s)
- Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden
| | - Ulrika Müssener
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nadine Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hugo López-Pelayo
- Grup Addiccions Clínic (GRA-GRE), Hospital Clínic de Barcelona, IDIBAPS, RTA, University of Barcelona, Barcelona, Spain
| | - Jorge Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Antoni Gual
- Grup Addiccions Clínic (GRA-GRE), Hospital Clínic de Barcelona, IDIBAPS, RTA, University of Barcelona, Barcelona, Spain
| | - Jillian Reynolds
- Grup Addiccions Clínic (GRA-GRE), Hospital Clínic de Barcelona, IDIBAPS, RTA, University of Barcelona, Barcelona, Spain
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study. BMC FAMILY PRACTICE 2016; 17:70. [PMID: 27267887 PMCID: PMC4895893 DOI: 10.1186/s12875-016-0461-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 05/20/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. METHODS Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. RESULTS Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro- level such as societal and political culture the effects risks to get nullified. CONCLUSIONS Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested. TRIAL REGISTRATION ClinicalTrials.gov. Trial identifier: NCT01501552 .
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Milward J, Khadjesari Z, Fincham-Campbell S, Deluca P, Watson R, Drummond C. User Preferences for Content, Features, and Style for an App to Reduce Harmful Drinking in Young Adults: Analysis of User Feedback in App Stores and Focus Group Interviews. JMIR Mhealth Uhealth 2016; 4:e47. [PMID: 27220371 PMCID: PMC4897297 DOI: 10.2196/mhealth.5242] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 12/01/2022] Open
Abstract
Background Electronic screening and brief intervention (eSBI) is effective in reducing weekly alcohol consumption when delivered by a computer. Mobile phone apps demonstrate promise in delivering eSBI; however, few have been designed with an evidence-based and user-informed approach. Objective This study aims to explore from a user perspective, preferences for content, appearance, and operational features to inform the design of a mobile phone app for reducing quantity and frequency of drinking in young adults engaged in harmful drinking (18-30 year olds). Methods Phase 1 included a review of user reviews of available mobile phone apps that support a reduction in alcohol consumption. Apps were identified on iTunes and Google Play and were categorized into alcohol reduction support, entertainment, blood alcohol content measurement (BAC), or other. eSBI apps with ≥18 user reviews were subject to a content analysis, which coded praise, criticism, and recommendations for app content, functionality, and esthetics. Phase 2 included four focus groups with young adults drinking at harmful levels and residing in South London to explore their views on existing eSBI apps and preferences for future content, functionality, and appearance. Detailed thematic analysis of the data was undertaken. Results In Phase 1, of the 1584 apps extracted, 201 were categorized as alcohol reduction, 154 as BAC calculators, 509 as entertainment, and 720 as other. We classified 32 apps as eSBI apps. Four apps had ≥18 user reviews: Change for Life Drinks Tracker, Drinksmeter, Drinkaware, and Alcohol Units Calculator. The highest proportion of content praises were for information and feedback provided in the apps (12/27, 44%), followed by praise for the monitoring features (5/27, 19%). Many (8/12, 67%) criticisms were for the drinking diary; all of these were related to difficulty entering drinks. Over half (18/32, 56%) of functionality criticisms were descriptions of software bugs, and over half of those (10/18, 56%) were for app crashing or freezing. Drinksmeter and Alcohol Units Calculator were the most highly praised apps overall (23/57 and 22/57; 39% of praise overall). In Phase 2, two main themes were identified. The meaningfulness theme reflected how young adults thought apps needed to be tailored to the interests and values of their age group, particularly emphasizing content and feedback around broader health and well-being factors such as exercise, diet, and image. The community theme suggested that young adults want to be able to engage with other app users, both in groups of friends and with online users for motivation and support. Conclusions Targeted and relevant information and feedback, in addition to easy-to-use monitoring tools, were found to be important features of a mobile phone app to support a reduction in drinking. Future app development should consider tailoring all app aspects to the needs of young adults, considering broader well-being monitoring tools and online community functions.
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Affiliation(s)
- Joanna Milward
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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Chavez LJ, Williams EC, Lapham GT, Rubinsky AD, Kivlahan DR, Bradley KA. Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions. J Stud Alcohol Drugs 2016; 77:500-8. [PMID: 27172583 PMCID: PMC4869906 DOI: 10.15288/jsad.2016.77.500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. METHOD This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year. RESULTS Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. CONCLUSIONS The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.
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Affiliation(s)
- Laura J. Chavez
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Emily C. Williams
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
| | - Gwen T. Lapham
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Group Health Research Institute, Seattle, Washington
| | - Anna D. Rubinsky
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - Daniel R. Kivlahan
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Katharine A. Bradley
- Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
- Group Health Research Institute, Seattle, Washington
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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45
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Parcesepe AM, L Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial. Drug Alcohol Depend 2016; 161:21-8. [PMID: 26872880 PMCID: PMC4936780 DOI: 10.1016/j.drugalcdep.2015.12.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. DESIGN Randomized controlled trial. SETTING HIV prevention drop-in centers in Mombasa, Kenya. PARTICIPANTS 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). INTERVENTION 6 session alcohol harm reduction intervention. COMPARATOR 6 session non-alcohol related nutrition intervention. MEASUREMENTS In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. FINDINGS The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. CONCLUSIONS The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.
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Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States.
| | - Kelly L L Engle
- FHI 360, 359 Blackwell St., Durham, NC 27701, United States; Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, United States
| | - Sandra L Martin
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Sherri Green
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), PO Box 21761 Ngong Road, 00505 Nairobi, Kenya
| | - Chirayath Suchindran
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Rosenau Hall, Chapel Hill, NC, United States
| | - Ilene S Speizer
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States
| | - Peter Mwarogo
- FHI 360, The Chancery 2nd and 3rd Floor Valley Road, PO Box 38835-00623, Nairobi, Kenya
| | - Nzioki Kingola
- International Center for Reproductive Health, PO Box 91109, Mombasa, Kenya
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Rosón B, Corbella X, Perney P, Santos A, Stauber R, Lember M, Arutyunov A, Ruza I, Vaclavik J, García L, Pujol R, Stauber R, Vogel W, Vaclavik J, Gajdová J, Smrzova A, Liberdová A, Cibickova L, Plasek J, Svarcova T, Salupere R, Lember M, Rosón B, Guillem MN, Fernández-Sola J, Zapatero A, Monte R, Puerta RB, Gamallo R, Durán C, Perney P, Ouakli A, Oziol E, Bastide D, Tourneaire P, Allard G, Cros H, Piala JM, Quere I, Condouret S, Ruža I, Funka K, Zarina L, Barata J, Gonsalves O, Santos A, Oliveira N, Yakushin S, Petrovicheva L, Sleptsov A, Arutyunov A, Mitkhat G, Marusenko I. Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study. Alcohol Alcohol 2016; 51:457-64. [DOI: 10.1093/alcalc/agv142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/30/2015] [Indexed: 11/14/2022] Open
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Berman AH, Gajecki M, Fredriksson M, Sinadinovic K, Andersson C. Mobile Phone Apps for University Students With Hazardous Alcohol Use: Study Protocol for Two Consecutive Randomized Controlled Trials. JMIR Res Protoc 2015; 4:e139. [PMID: 26693967 PMCID: PMC4704963 DOI: 10.2196/resprot.4894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/15/2015] [Indexed: 11/25/2022] Open
Abstract
Background About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (≥6 for women; ≥8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has access to a Web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve. Trial Registration ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02064998 (Archived by WebCite at http://www.webcitation.org/6dy0AlVRP)
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Affiliation(s)
- Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Comparative trial of the WHO ASSIST-linked brief intervention and simple advice for substance abuse in primary care. Asian J Psychiatr 2015; 18:75-80. [PMID: 26412051 DOI: 10.1016/j.ajp.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 09/07/2015] [Accepted: 09/12/2015] [Indexed: 11/22/2022]
Abstract
To help decrease the burden of substance-related problems, the World Health Organization developed the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) - a sensitive screening questionnaire to help identify misuse of alcohol and other substances - linked to Brief Intervention (BI). This paper compares the effectiveness of the ASSIST followed either by its linked BI or by simple advice (SA). The trial was conducted in southern Thailand. The ASSIST was used to screen patients attending primary care units and categorise them into 'low-risk', 'moderate-risk' and 'high-risk' groups. Patients at 'moderate-risk' were randomised to receive ASSIST-linked BI (n=120) or SA (n=116). The outcome measures were changes in the ASSIST-Specific Substance Involvement Scores (ASSIST-SSIS), ASSIST-Total Substance Involvement Scores (ASSIST-TSIS) and proportions of patients whose scores at three and six months had decreased from the 'moderate-risk' to 'low-risk' category. 147 patients (72 BI; 75 SA) completed the six-month trial. There were significant reductions in both ASSIST-SSIS and ASSIST-TSIS, with no significant difference between groups. The percentages of patients converted to the 'low-risk' category were 36.7% and 38.8% at month 3, and 53.3% and 53.4% at month 6, for the BI and SA groups, respectively. In conclusion, in primary care administering the ASSIST and telling patients their score, followed either by formal brief intervention or simple advice, are equally effective in decreasing substance use for up to six months.
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Otete HE, Orton E, West J, Fleming KM. Sex and age differences in the early identification and treatment of alcohol use: a population-based study of patients with alcoholic cirrhosis. Addiction 2015; 110:1932-40. [PMID: 26235801 DOI: 10.1111/add.13081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 01/14/2023]
Abstract
AIM To estimate sex differences in health-care utilization among harmful/hazardous drinkers in the period before alcoholic cirrhosis diagnosis, and estimate sex differences in the extent to which alcohol use and brief alcohol interventions were documented for these individuals compared with a control cohort. DESIGN Retrospective study using linked general practice and hospital admissions data in England. SETTING Three hundred and fifty-seven general practitioner (GP) practices in England. PARTICIPANTS A total of 2479 individuals with alcoholic cirrhosis (mean age at diagnosis=56 years), of whom 67% were men; and 24,790 controls without the disease. MEASUREMENTS Rates of primary care visits and hospital admissions prior to the diagnosis of alcoholic cirrhosis for men and women, and the proportion of men and women with alcohol consumption and/or alcohol brief intervention documented in their medical record. FINDINGS Compared with the general population, patients with alcoholic cirrhosis used primary and secondary health-care services more frequently in the years leading up to their diagnosis. In the years prior to diagnosis, men used primary and secondary health-care services more than did women (P for sex interaction P<0.0001). Men were more likely than women to have their alcohol use recorded [odds ratio (OR) men=1.96, 95% confidence interval (CI)=1.7-2.3; women=1.63, 95% CI=1.4-1.8, P for sex interaction P<0.0017]. By contrast, alcohol interventions were recorded more commonly among women (OR men=4.3, 95% CI=3.7-4.9; women=5.8, 95% CI=4.7-6.9, P for sex interaction=0.07), although less common with increasing age (P for age interaction=0.009). CONCLUSIONS In the United Kingdom, prior to alcoholic cirrhosis diagnosis, excess health-care utilization is higher in men than women and men are more likely than women to have their alcohol use recorded. However, women appear to be more likely than men to receive alcohol brief interventions.
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Affiliation(s)
- Harmony E Otete
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.,UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City hospital Campus, Clinical Sciences Building, Nottingham, NG5 1PB, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University Park,University of Nottingham, Nottingham, NG7 2UH, UK
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Kate M Fleming
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.,UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City hospital Campus, Clinical Sciences Building, Nottingham, NG5 1PB, UK
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50
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McNeely J, Cleland CM, Strauss SM, Palamar JJ, Rotrosen J, Saitz R. Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients. J Gen Intern Med 2015; 30:1757-64. [PMID: 25986138 PMCID: PMC4636560 DOI: 10.1007/s11606-015-3391-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/16/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. OBJECTIVE We sought to validate SISQs for self-administration in primary care patients. DESIGN Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. PARTICIPANTS Adult patients aged 21-65 years were consecutively enrolled from two urban safety-net primary care clinics. MAIN MEASURES The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. KEY RESULTS Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3-80.3) and specificity of 84.7 % (95 % CI 80.2-88.5), AUC = 0.79 (95 % CI 0.75-0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4-94.1) and specificity of 74.2 % (95 % CI 69.6-78.4), AUC = 0.80 (95 % CI 0.76-0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4-79.1) and specificity of 94.3 % (95 % CI 91.3-96.6), AUC = 0.83 (95 % CI 0.79-0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0-92.3) and specificity of 88.6 % (95 % CI 85.0-91.6), AUC = 0.87 (95 % CI 0.83-0.91), for drug use disorder. CONCLUSIONS The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University School of Medicine, 550 1st Ave., VZ30 6th Floor, New York, NY, 10016, USA. .,Department of Medicine, Division of General Internal Medicine, New York, NY, USA. .,Center for Drug Use and HIV Research, New York, NY, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, NY, USA.,NYU College of Nursing, New York, NY, USA
| | - Shiela M Strauss
- Center for Drug Use and HIV Research, New York, NY, USA.,NYU College of Nursing, New York, NY, USA
| | - Joseph J Palamar
- Department of Population Health, New York University School of Medicine, 550 1st Ave., VZ30 6th Floor, New York, NY, 10016, USA.,Center for Drug Use and HIV Research, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
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