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Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
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Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
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Beyer FR, Kenny RPW, Johnson E, Caldwell DM, Garnett C, Rice S, Simpson J, Angus C, Craig D, Hickman M, Michie S, Kaner EFS. Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta-analysis. Addiction 2023; 118:17-29. [PMID: 35815387 PMCID: PMC10087505 DOI: 10.1111/add.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
AIM To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption. DESIGN Systematic review and network meta-analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta-analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta-analysis (CINeMA) tool was used to assess confidence in effect sizes. SETTING Online or community or health settings where the intervention was immediately accessible without referral. PARTICIPANTS Non treatment-seeking hazardous or harmful drinkers. MEASUREMENTS Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate. FINDINGS Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: -23 g/wk (95% CI, -43 to -2); 6 months: -14 g/wk [95% CI, -25 to -3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (-6 g/wk [95% CI, -24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months. CONCLUSION Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference.
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Affiliation(s)
- Fiona R Beyer
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Ryan P W Kenny
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, London, UK
| | - Stephen Rice
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Julija Simpson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Matt Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Susan Michie
- Director of UCL Centre for Behaviour Change, University College London, London, UK
| | - Eileen F S Kaner
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
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3
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Kuwabara Y, Kinjo A, Fujii M, Minobe R, Maesato H, Higuchi S, Yoshimoto H, Jike M, Otsuka Y, Itani O, Kaneita Y, Kanda H, Kasuga H, Ito T, Osaki Y. Effectiveness of nurse-delivered screening and brief alcohol intervention in the workplace: A randomized controlled trial at five Japan-based companies. Alcohol Clin Exp Res 2022; 46:1720-1731. [PMID: 35869628 DOI: 10.1111/acer.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive alcohol use is a leading cause of global morbidity and premature mortality. This study evaluated the effectiveness of two types of nurse-delivered interventions to reduce excessive alcohol consumption among screened participants using the alcohol use disorders identification test (AUDIT) in the workplace. METHODS A randomized controlled trial involving AUDIT-positive employees of five Japan-based companies was conducted. A total of 351 participants were randomized into groups that received a patient information leaflet (PIL), 5 min of brief advice, or 15 min of brief advice and counseling. Outcomes (weekly alcohol consumption and drinking and binge drinking frequency in the previous 30 days) were evaluated at 6 and 12-month follow-up. RESULTS The follow-up rates were 96.3% (n = 338) and 94.9% (n = 333) at 6 and 12 months, respectively. At 6 months, the mean change in weekly alcohol consumption was -38.1 g (-1.64 US fluid oz/week) in the 15-min brief advice and counseling group, which differed significantly from the PIL group. The reduction in the advice and counseling group persisted at 12-month follow-up but was no longer significantly different from the PIL group. There was no significant change in alcohol consumption observed in the 5-min brief advice group. Improvement in drinking and binge drinking frequency was observed in all three groups. CONCLUSIONS Nurse-delivered 15-min brief advice and counseling was effective over a 6-month period in reducing alcohol consumption in a workplace setting. This finding suggests that the implementation of workplace screening and brief intervention could play a useful role in preventing the burden of harmful alcohol use.
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Affiliation(s)
- Yuki Kuwabara
- Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Aya Kinjo
- Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Maya Fujii
- Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Ruriko Minobe
- National Institute of Alcoholism, Kurihama National Hospital, Kanagawa, Japan
| | - Hitoshi Maesato
- National Institute of Alcoholism, Kurihama National Hospital, Kanagawa, Japan
| | - Susumu Higuchi
- National Institute of Alcoholism, Kurihama National Hospital, Kanagawa, Japan
| | - Hisashi Yoshimoto
- Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, Majors of Medical Science, University of Tsukuba, Ibaragi, Japan
| | - Maki Jike
- Department of Food Science and Nutrition, Faculty of Life and Environmental Science, Showa Women's University, Tokyo, Japan
| | - Yuichiro Otsuka
- Department of Public Health, School of Medicine, Nihon University, Tokyo, Japan
| | - Osamu Itani
- Department of Public Health, School of Medicine, Nihon University, Tokyo, Japan
| | - Yoshitaka Kaneita
- Department of Public Health, School of Medicine, Nihon University, Tokyo, Japan
| | - Hideyuki Kanda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Teruna Ito
- Department of Food and Nutrition, Koriyama Women's university, Koriyama, Japan
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
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4
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Ferreira ML, Sartes LMA. Effectiveness of Brief Intervention for Alcohol Use: a Randomized Trial. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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5
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Birch JM, Critchlow N, Calman L, Petty R, Rosenberg G, Rumgay H, Vohra J. The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer's Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK. Alcohol Alcohol 2021; 56:433-442. [PMID: 33179022 DOI: 10.1093/alcalc/agaa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers' (CMO) revised low-risk drinking guidelines are appropriately advised. METHODS Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January-March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). RESULTS The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. CONCLUSION Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.
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Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge School of Clinical, Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Nathan Critchlow
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Robert Petty
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Gillian Rosenberg
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Harriet Rumgay
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
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Snowden C, Lynch E, Avery L, Haighton C, Howel D, Mamasoula V, Gilvarry E, McColl E, Prentis J, Gerrand C, Steel A, Goudie N, Howe N, Kaner E. Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32131964 DOI: 10.3310/hta24120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. OBJECTIVES To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. DESIGN A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. SETTING The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. PARTICIPANTS Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. INTERVENTIONS The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. MAIN OUTCOME MEASURES Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. RESULTS The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. CONCLUSIONS The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. TRIAL REGISTRATION Current Controlled Trials ISRCTN36257982. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Christopher Snowden
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Valentina Mamasoula
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Newcastle Addictions Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - James Prentis
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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7
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Beyer FR, Campbell F, Bertholet N, Daeppen JB, Saunders JB, Pienaar ED, Muirhead CR, Kaner EFS. The Cochrane 2018 Review on Brief Interventions in Primary Care for Hazardous and Harmful Alcohol Consumption: A Distillation for Clinicians and Policy Makers. Alcohol Alcohol 2020; 54:417-427. [PMID: 31062859 DOI: 10.1093/alcalc/agz035] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/26/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. METHODS Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. RESULTS We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference -20 g/wk, 95% confidence interval -28 to -12). Subgroup analysis showed a similar effect for men and women. CONCLUSIONS Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.
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Affiliation(s)
- F R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - F Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - N Bertholet
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - J B Daeppen
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - J B Saunders
- Department of Psychiatry, Royal Brisbane and Women's Hospital, University of Queensland/Royal Brisbane Hospital, Australia
| | - E D Pienaar
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - C R Muirhead
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - E F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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8
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Gonzalez Y, Kozachik SL, Hansen BR, Sanchez M, Finnell DS. Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review. J Am Psychiatr Nurses Assoc 2020; 26:27-42. [PMID: 31509044 DOI: 10.1177/1078390319872536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.
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Affiliation(s)
- Yovan Gonzalez
- Yovan Gonzalez, DNP, FNP-BC, New York City Health and Hospitals/Gouverneur, New York, NY, USA
| | - Sharon L Kozachik
- Sharon L. Kozachik, PhD, RN, FAAN, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan R Hansen
- Bryan R. Hansen, PhD, RN, APRN-CNS, ACNS-BC, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Sanchez
- Michael Sanchez, DNP, ARNP, NP-C, FNP-BC, AAHIVS, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah S Finnell
- Deborah S. Finnell, DNS, RN, CARN-AP, FAAN, Johns Hopkins University, Baltimore, MD, USA
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9
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Romero Rodríguez EM, Pérula de Torres LÁ, Linares Ruiz A, Fernández García JÁ, Parras Rejano JM, Roldán Villalobos A. [Effectiveness of training programs on alcohol consumption in the Primary Care setting: Systematic review]. Aten Primaria 2019; 51:536-547. [PMID: 30262224 PMCID: PMC6945138 DOI: 10.1016/j.aprim.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/06/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems. DESIGN A systematic review of randomised controlled trials. DATA SOURCES Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017. STUDY SELECTION The final sample was n=3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included. DATA EXTRACTION The main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required. RESULTS Three Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention. CONCLUSION The development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques.
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Affiliation(s)
- Esperanza María Romero Rodríguez
- Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España.
| | - Luis Ángel Pérula de Torres
- Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España; Unidad Docente de Medicina Familiar y Comunitaria, Distrito Sanitario de Córdoba y Guadalquivir, Córdoba, España; Programa de Actividades Preventivas y de Promoción de la Salud -PAPPS- (semFYC), Barcelona, España; Grupo de Evaluación y mejora del PAPPS (semFYC)
| | | | - José Ángel Fernández García
- Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España; Consultorio de Villarrubia, Servicio Andaluz de Salud, Córdoba, España
| | - Juan Manuel Parras Rejano
- Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España; Consultorio de Villanueva del Rey. Servicio Andaluz de Salud, Córdoba, España
| | - Ana Roldán Villalobos
- Grupo de investigación Clínico-Epidemiológica en Atención Primaria (GICEAP), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España; Centro de Salud Carlos Castilla del Pino, Servicio Andaluz de Salud, Córdoba, España
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Reid C, Fenech M, Jones L, Saleh A. Nurse practitioner alcohol intervention for people with viral hepatitis: Randomised controlled trial. Collegian 2019. [DOI: 10.1016/j.colegn.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Assessing the impact of computerised and written advice in changing the habit and behaviour of alcohol use in patients who have suffered alcohol-related facial injuries-a pilot study. Oral Maxillofac Surg 2019; 23:149-157. [PMID: 30762139 DOI: 10.1007/s10006-019-00749-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Alcohol screening and a brief intervention (SBI) can be effective in changing harmful drinking behaviour and reducing the chance of future alcohol-related traumas. However, there is no standardised method in its application. This study aims to deliver a novel method of SBI to patients with alcohol-related facial fractures and to assess changes in their alcohol intake and attitudes to drinking following this intervention. METHODS Twenty consecutive patients at two Victorian Hospitals were consented to undergo a novel SBI program. This study analysed the results of the initial survey and the follow-up survey completed at least 3 months later. RESULTS Of the 20 patients recruited for the initial survey, 18 returned for the follow-up (90% response rate). All patients were males, 50% were aged between 18 and 29 years, 61% involved in interpersonal violence, 56% sustained mandibular fractures and 89% underwent surgery. The alcohol risk score increased in the follow-up survey; however, the relationship is not statistically significant. A high proportion of the patients were still unaware of their risk. Patients showed greater awareness of their drinking and willingness to accept help and more readiness to accept written advice rather than computerised materials. CONCLUSION This study found a high rate of acceptance among trauma patients to the intervention program. Although there was no significant change in the risk scores between the initial and follow-up surveys, certain subgroup was more amenable to the intervention given. There is generally an improvement in the attitudes towards and knowledge of harmful drinking.
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Taylor G, McMahon C, Reeves L, Hickman M. 'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation. J Public Health (Oxf) 2018; 40:381-388. [PMID: 28977388 PMCID: PMC6053838 DOI: 10.1093/pubmed/fdx090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/18/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs' perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
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Affiliation(s)
- J Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - F Fox
- University Hospital Bristol, NHS Foundation Trust, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Kaner
- Institute of Health & Society, University of Newcastle, Newcastle upon Tyne, UK
| | - G Taylor
- Department for Health, University of Bath, Bath, UK
| | - C McMahon
- B&NES Council Public Health, Bath, UK
| | | | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
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Mitchell AM, King DK, Kameg B, Hagle H, Lindsay D, Hanson BL, Kane I, Puskar K, Albrecht S, Shaputnic C, Porter BR, Edwards AE, Knapp E. An Environmental Scan of the Role of Nurses in Preventing Fetal Alcohol Spectrum Disorders. Issues Ment Health Nurs 2018; 39:151-158. [PMID: 29370546 DOI: 10.1080/01612840.2017.1384873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.
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Affiliation(s)
- Ann M Mitchell
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
| | - Diane K King
- b Center for Behavioral Health Research and Services (CBHRS), Institute of Social and Economic Research, University of Alaska Anchorage , Anchorage , AK
| | - Brayden Kameg
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
| | - Holly Hagle
- c Institute for Research, Education and Training in Addictions , Pittsburgh , PA
| | - Dawn Lindsay
- d Institute for Research, Education and Training in Addictions , Pittsburgh , PA
| | - Bridget L Hanson
- e Center for Behavioral Health Research & Services, University of Alaska Anchorage , Anchorage , AK
| | - Irene Kane
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
| | - Kathy Puskar
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
| | - Susan Albrecht
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
| | - Carolyn Shaputnic
- f Institute for Fetal Alcohol Spectrum Disorders Discovery, Institute for Fetal Alcohol Spectrum Disorders Discovery at UCSD , La Jolla , CA
| | - Becky R Porter
- g Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage , Anchorage , AK
| | - Alexandra E Edwards
- g Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage , Anchorage , AK
| | - Emily Knapp
- a Health and Community Systems , University of Pittsburgh School of Nursing , Pittsburgh , Pennsylvania , USA
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Stephen C, McInnes S, Halcomb E. The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review. J Adv Nurs 2017; 74:279-288. [DOI: 10.1111/jan.13450] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Catherine Stephen
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Susan McInnes
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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Cowell AJ, Dowd WN, Mills MJ, Hinde JM, Bray JW. Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs. Addiction 2017; 112 Suppl 2:101-109. [PMID: 28074564 DOI: 10.1111/add.13650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/17/2013] [Accepted: 06/02/2014] [Indexed: 11/28/2022]
Abstract
AIMS To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments. DESIGN A mathematical model was used to estimate the number of patients needed for revenues to exceed costs. SETTING Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists. PARTICIPANTS Practitioners in seven SBIRT programs who received grants from the US Substance Abuse and Mental Health Services Administration (SAMHSA). MEASUREMENTS Program costs and revenues were measured using data from grantees. Patient flows were measured from administrative data and adjusted with prevalence and screening estimates from the literature. FINDINGS SBIRT can be sustained through health insurance reimbursement in out-patient and emergency department settings in most staffing mixes. To sustain SBIRT in in-patient programs, a patient flow larger than the national average may be needed; if that flow is achieved, the range of screens required to maintain a surplus is narrow. Sensitivity analyses suggest that the results are very sensitive to changes in the proportion of insured patients. CONCLUSIONS Screening, Brief Intervention and Referral to Treatment programs in the United States can be sustained by health insurance payments under a variety of staffing models. Screening, Brief Intervention and Referral to Treatment programs can be sustained only in an in-patient setting with above-average patient flow (more than 2500 screens). Screening, Brief Intervention and Referral to Treatment programs in out-patient and emergency department settings can be sustained with below-average patient flows (fewer than 125 000 out-patient visits and fewer than 27 000 emergency department visits).
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Affiliation(s)
| | | | | | | | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
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17
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Wong JYH, Chan MMK, Lok KYW, Ngai VFW, Pang MTH, Chan CKY, Yau JHY, Choi EPH, Fong SSM. Chinese women health ambassadors programme: A process evaluation. J Clin Nurs 2016; 26:2976-2985. [PMID: 27862523 DOI: 10.1111/jocn.13638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess a community-women health ambassadors programme and report the areas that were successful and those that required improvement. The objectives were to assess the feasibility, effectiveness, implementation and sustainability of the programme. BACKGROUND Health promotion for the prevention of chronic diseases has always been the top priority in the health sector. To ensure that the relevant health messages are well received in local communities, a health promotion programme must be accessible, acceptable and culturally relevant. DESIGN We conducted and evaluated a women health ambassador programme based on the lay health advisor model for health promotion in Hong Kong during November 2014 to February 2015. Health needs and the subsequent focus of the programme were determined by underprivileged Chinese women. METHODS University health educators from different disciplines trained the women (N = 80) to be health ambassadors through mini-lectures and training workshops. The trained women raised awareness about the importance of health within their families and social networks. The programme was evaluated through attendance rates, questionnaires and quizzes, changes in knowledge and behaviour, as well as qualitative discussion. RESULTS While the majority of participants found the programme valuable and useful, retention rates were unideal. A statistically significant improvement was found in eating habits, but no significant change was identified for other knowledge and behaviour assessments. CONCLUSIONS The programme empowered underprivileged women to reflect on the importance of health, take responsibility for their own health and actively promote health to their families and personal communities. RELEVANCE TO CLINICAL PRACTICE Our study supports that health promotion programmes based on the lay health advisor model are effective and encourage large-scale programmes of this nature. Our results also support that future health promotion efforts should deliver brief, clear and simple content as opposed to intricate information.
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Affiliation(s)
- Janet Yuen Ha Wong
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Maggie Mee Kie Chan
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kris Yuet Wan Lok
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Vivian Fei Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Michelle Tsz Ha Pang
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Claudia Kor Yee Chan
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jessie Ho Yin Yau
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edmond Pui Hang Choi
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shirley Siu Ming Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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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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Watson JM, Fairhurst C, Li J, Tober G, Crosby H, Lloyd C, Godfrey C, Mdege ND, Dale V, Toner P, Parrott S, Raistrick D. ADAPTA: A pilot randomised controlled trial of an alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting. Drug Alcohol Depend 2015; 154. [PMID: 26194955 PMCID: PMC4545229 DOI: 10.1016/j.drugalcdep.2015.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To examine the relative feasibility, acceptability, applicability, effectiveness and explore cost-effectiveness of a healthy living focused intervention (HL) compared to an alcohol-focused intervention (AF) for problem drinkers identified in hospital. METHODS A pragmatic, randomised, controlled, open pilot trial. Feasibility and acceptability were measured by recruitment, attrition, follow-up rates and number of treatment sessions attended. Effectiveness was measured using the Alcohol Use Disorders Identification Test score at six months. Additional economic and secondary outcome measures were collected. RESULTS Eighty-six participants were randomised and 72% (n=62) were retained in full participation. Forty-one participants attended at least one treatment session (48%). A greater proportion in the HL group attended all four treatment sessions (33% vs 19%). Follow-up rates were 29% at six months and 22% at twelve months. There was no evidence of a difference in AUDIT score between treatment groups at six months. Mean cost of health care and social services, policing and the criminal justice system use decreased while EQ-5D scores indicated minor improvement in both arms. However, this pilot trial was not powered to detect differences in either measure between groups. CONCLUSIONS While no treatment effect was observed, this study demonstrated a potential to engage patients drinking at harmful or dependent levels in a healthy living intervention. However, recruitment proved challenging and follow-up rates were poor. Better ways need to be found to help these patients recognise the harms associated with their drinking and overcome the evident barriers to their engagement with specialist treatment.
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Affiliation(s)
- Judith M. Watson
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Caroline Fairhurst
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Jinshuo Li
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Gillian Tober
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Helen Crosby
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Charlie Lloyd
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Christine Godfrey
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Noreen D. Mdege
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Veronica Dale
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Paul Toner
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Steve Parrott
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Duncan Raistrick
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
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Elzerbi C, Donoghue K, Drummond C. A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries: a systematic review and meta-analysis of randomized controlled trials. Addiction 2015; 110:1082-91. [PMID: 25916993 DOI: 10.1111/add.12960] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/23/2014] [Accepted: 04/22/2015] [Indexed: 12/01/2022]
Abstract
AIMS The extent of variation attributable to regional differences for the efficacy of brief intervention (BI) to reduce hazardous and harmful alcohol consumption is unclear. The primary aim of this study was to determine overall efficacy of BI at 6- and 12-month follow-up in primary health care (PHC) and emergency department (ED) studies. The secondary aim was to examine whether variance in study outcome can be explained by the geographical region in which trials have taken place (European versus non-European). METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) published before August 2014 was undertaken. Twenty RCTs conducted in PHC settings with a total of 8226 participants (European = 4564/non-European = 3662) and eight RCTs conducted in ED settings with a total of 4799 participants (European = 2465/non-European = 2334) were eligible. Primary outcome measure was reduction in grams of alcohol consumed per week for BI and control groups at 6- and 12-month follow-up. An inverse variance model was applied to measure the effect of treatment in mean differences for BI and control groups at 6- and 12-month follow-up. Variance between study outcomes was explored using subgroup analysis of European versus non-European countries. RESULTS For PHC trials at 6-month follow-up, statistically significant benefits of BI were indicated [mean difference (MD) = -21.98 g/week; 95% confidence interval (CI) = -37.40 to -6.57; P = 0.005]. At 12-month follow-up, statistically significant benefit of BI was evident (MD = -30.86 g/week; 95% CI = -46.49 to -15.23; P = 0.0001). For ED trials at 6-month follow-up, statistically significant benefits of BI were indicated (MD = -17.97 g/week; 95% CI = -29.69 to -6.24; P = .003). At 12-month follow-up, statistically significant benefit in favour of BI was evident (MD = -18.21 g/week; 95% CI = -26.71 to -9.70; P < 0.0001). No statistically significant differences were detected in subgroup analyses of outcomes for European versus non-European studies. CONCLUSIONS Brief intervention (BI) to reduce alcohol consumption is associated with reducing grams of alcohol consumed per week among hazardous and harmful drinkers at 6- and 12-month follow-up in primary health care and emergency department trials. The geographical region in which trials are undertaken does not appear to explain the variance in trial outcomes for reducing alcohol consumption.
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Affiliation(s)
- Catherine Elzerbi
- National Addiction Centre, Addictions Department, King's College London, London, UK
| | - Kim Donoghue
- National Addiction Centre, Addictions Department, King's College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Addictions Department, King's College London, London, UK
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Angus C, Latimer N, Preston L, Li J, Purshouse R. What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care. Front Psychiatry 2014; 5:114. [PMID: 25225487 PMCID: PMC4150206 DOI: 10.3389/fpsyt.2014.00114] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. METHODS Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. RESULTS The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. CONCLUSION This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nicholas Latimer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jessica Li
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Robin Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Heather N. The efficacy-effectiveness distinction in trials of alcohol brief intervention. Addict Sci Clin Pract 2014; 9:13. [PMID: 25127717 PMCID: PMC4134461 DOI: 10.1186/1940-0640-9-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/31/2014] [Indexed: 11/27/2022] Open
Abstract
Three recent sets of null findings from trials of alcohol brief intervention (BI) have been disappointing to those who wish to see a reduction in alcohol-related harm through the widespread dissemination of BI. Saitz (7) has suggested that these null findings result from a failure to translate the effects of BI seen in efficacy trials, which are thought to contribute mainly to the beneficial effects of BI shown in meta-analyses, to effectiveness trials conducted in real-world clinical practice. The present article aims to: (i) clarify the meaning of the terms “efficacy” and “effectiveness” and other related concepts; (ii) review the method and findings on efficacy-effectiveness measurement in the 2007 Cochrane Review by Kaner and colleagues; and (iii) make suggestions for further research in this area. Conclusions are: 1) to avoid further confusion, terms such as “efficacy trial”, “effectiveness trial”, “clinical representativeness”, etc. should be clearly defined and carefully used; 2) applications of BI to novel settings should begin with foundational research and developmental studies, followed by efficacy trials, and political pressures for quick results from premature effectiveness trials should be resisted; 3) clear criteria are available in the literature to guide progress from efficacy research, through effectiveness research, to dissemination in practice; 4) to properly interpret null findings from effectiveness studies, it is necessary to ensure that interventions are delivered as intended; 5) in future meta-analyses of alcohol BI trials, more attention should be paid to the development and application of a psychometrically robust scale to measure efficacy-effectiveness or clinical representativeness; 6) the null findings under consideration cannot be firmly attributed to a failure to translate effects from efficacy trials to real-world practice, because it is possible that the majority of trials included in meta-analyses on which the evidence for the beneficial effects of alcohol BI was based tended to be effectiveness rather than efficacy trials; and 7) a hypothesis to explain the null findings in question is that they are due to lack of fidelity in the implementation of BI in large, organizationally complex, cluster randomized trials.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
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Clossick E, Woodward S. Effectiveness of alcohol brief interventions in general practice. ACTA ACUST UNITED AC 2014; 23:574-80. [DOI: 10.12968/bjon.2014.23.11.574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Sue Woodward
- Lecturer, Florence Nightingale School of Nursing and Midwifery, King's College London
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Joseph J, Basu D, Dandapani M, Krishnan N. Are nurse-conducted brief interventions (NCBIs) efficacious for hazardous or harmful alcohol use? A systematic review. Int Nurs Rev 2014; 61:203-10. [PMID: 24645911 DOI: 10.1111/inr.12096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare the efficacy of nurse-conducted brief interventions in reducing alcohol consumption, by looking at with treatment as usual compared with other treatments and general physician-delivered brief interventions within the literature. BACKGROUND Globally, the consumption of alcohol is at a worrying level and has significant effects on health when consumed to excess. Numerous studies have reported that brief intervention is effective in reducing excessive drinking. However, evidence on the efficacy of such interventions by nurses is still inconclusive. METHODS We included randomized controlled trials of brief interventions in which nurses were primarily involved as therapists, and were designed to achieve a reduction in alcohol consumption and related problems. We used online searches to locate randomized controlled trials in this area published from 1995 till 2012. FINDINGS Eleven trials were found meeting inclusion criteria, comparing nurse-conducted brief interventions with a control group or with other treatments. Five trials reported a statistically significant reduction in alcohol consumption in the intervention group with 6-12-month follow-up period and two trials concluded that brief interventions delivered by nurses was as efficacious as by physicians. IMPLICATIONS FOR NURSING POLICY The findings of the review have important policy implications for the preparation of nurses as therapists for brief interventions to reduce excessive drinking in a broad range of settings such as primary healthcare and hospital settings. The adoption of this intervention into contemporary nursing practice should be considered by the International Council of Nurses and nurses around the world as, according to the literature, it provides an evidence base for the independent functioning of nurses within the realms of nursing profession and addiction medicine. CONCLUSION The results of the review suggest that nurse-conducted brief interventions are an effective strategy for reducing alcohol consumption. We advocate more rigorous randomized controlled trials to underpin its efficacy in both research and real life scenario.
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Affiliation(s)
- J Joseph
- SUM Nursing College (SNC), Siksha 'O'Anusandhan University, Odisha, India
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Angus C, Scafato E, Ghirini S, Torbica A, Ferre F, Struzzo P, Purshouse R, Brennan A. Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy. BMC FAMILY PRACTICE 2014; 15:26. [PMID: 24502342 PMCID: PMC3936801 DOI: 10.1186/1471-2296-15-26] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/14/2014] [Indexed: 01/07/2023]
Abstract
Background As alcohol-related health problems continue to rise, the attention of policy-makers is increasingly turning to Screening and Brief Intervention (SBI) programmes. The effectiveness of such programmes in primary healthcare is well evidenced, but very few cost-effectiveness analyses have been conducted and none which specifically consider the Italian context. Methods The Sheffield Alcohol Policy Model has been used to model the cost-effectiveness of government pricing and public health policies in several countries including England. This study adapts the model using Italian data to evaluate a programme of screening and brief interventions in Italy. Results are reported as Incremental Cost-Effectiveness Ratios (ICERs) of SBI programmes versus a ‘do-nothing’ scenario. Results Model results show such programmes to be highly cost-effective, with estimated ICERs of €550/Quality Adjusted Life Year (QALY) gained for a programme of SBI at next GP registration and €590/QALY for SBI at next GP consultation. A range of sensitivity analyses suggest these results are robust under all but the most pessimistic assumptions. Conclusions This study provides strong support for the promotion of a policy of screening and brief interventions throughout Italy, although policy makers should be aware of the resource implications of different implementation options.
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Affiliation(s)
- Colin Angus
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK.
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Essex HN, White IR, Khadjesari Z, Linke S, McCambridge J, Murray E, Parrott S, Godfrey C. Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period. Qual Life Res 2013; 23:733-43. [PMID: 24026632 DOI: 10.1007/s11136-013-0521-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the ability of the EQ-5D to discriminate between levels of alcohol risk in a large sample of hazardous and harmful drinkers, and to explore the relationship between transitions between alcohol risk levels and changes in EQ-5D up to 12 months. METHODS This is a web-based randomised controlled trial evaluating a novel intervention for hazardous and harmful alcohol consumption. EQ-5D scores were compared among groups of drinkers at baseline (low/medium/high risk according to self-reported past week alcohol consumption), and changes in EQ-5D scores were estimated as a function of changes in alcohol consumption level. RESULTS Baseline EQ-5D scores were dominated by problems with anxiety/depression, which increased with alcohol risk level, whilst high-risk drinkers also experienced more problems with physical HRQoL dimensions. However, the tool demonstrated a considerable ceiling effect. At follow-up, despite considerable reductions in alcohol consumption across the sample, significant changes in aggregated EQ-5D index scores were only observed for high-risk drinkers at baseline who reduced their drinking, with small improvements (0.04-0.06) compared to those who did not reduce. CONCLUSIONS Our results suggest that the three-option EQ-5D may not be an optimal primary end point for measuring clinical and cost-effectiveness in randomised controlled trials of interventions among hazardous and harmful alcohol users, although further testing of the sensitivity of the tool in these populations is needed.
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Affiliation(s)
- Holly N Essex
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK,
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Alayli-Goebbels AF, Evers SM, Alexeeva D, Ament AJ, de Vries NK, Tilly JC, Severens JL. A review of economic evaluations of behavior change interventions: setting an agenda for research methods and practice. J Public Health (Oxf) 2013; 36:336-44. [DOI: 10.1093/pubmed/fdt080] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pereira MO, Anginoni BM, Ferreira NDC, Oliveira MAFD, Vargas DD, Colvero LDA. Efetividade da intervenção breve para o uso abusivo de álcool na atenção primária: revisão sistemática. Rev Bras Enferm 2013; 66:420-8. [PMID: 23887793 DOI: 10.1590/s0034-71672013000300018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 04/09/2013] [Indexed: 11/21/2022] Open
Abstract
A pesquisa identificou estudos clínicos acerca das intervenções breves para o uso abusivo de álcool e analisou a eficácia dos aconselhamentos para os consumidores. Estudo bibliográfico sistemático que utilizou artigos publicados no período de 1997 a 2010. Os achados mostraram que a estratégia de intervenção breve é efetiva na redução da frequência e quantidade de álcool, com melhores resultados quando aplicada na atenção primária. Todos os profissionais da área da saúde obtêm bons resultados com o manejo dessa terapia. Não foi possível definir se a estratégia é mais eficaz se aplicada em bebedores de uso nocivo ou em crônicos, uma vez que a intervenção depende da mobilização de recursos motivacionais do paciente e de mudanças de atitude relacionadas ao consumo de álcool.
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Puskar K, Gotham HJ, Terhorst L, Hagle H, Mitchell AM, Braxter B, Fioravanti M, Kane I, Talcott KS, Woomer GR, Burns HK. Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training on Nursing Students’ Attitudes Toward Working With Patients Who Use Alcohol and Drugs. Subst Abus 2013; 34:122-8. [DOI: 10.1080/08897077.2012.715621] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mdege ND, Watson J. Predictors of study setting (primary care vs. hospital setting) among studies of the effectiveness of brief interventions among heavy alcohol users: A systematic review. Drug Alcohol Rev 2013; 32:368-80. [DOI: 10.1111/dar.12036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Noreen Dadirai Mdege
- Addiction Research Group; Department of Health Sciences; University of York; York; UK
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31
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Keurhorst MN, Anderson P, Spak F, Bendtsen P, Segura L, Colom J, Reynolds J, Drummond C, Deluca P, van Steenkiste B, Mierzecki A, Kłoda K, Wallace P, Newbury-Birch D, Kaner E, Gual T, Laurant MGH. Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial. Implement Sci 2013; 8:11. [PMID: 23347874 PMCID: PMC3564747 DOI: 10.1186/1748-5908-8-11] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. METHODS/DESIGN In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals' role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. DISCUSSION Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.
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Affiliation(s)
- Myrna N Keurhorst
- Scientific Institute for Quality of Healthcare-IQ Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands.
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Cochran G, Field C. Brief intervention and social work: a primer for practice and policy. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:248-263. [PMID: 23731418 DOI: 10.1080/19371918.2013.759016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Most individuals in need of help for alcohol use disorders do not receive care. Screening and brief intervention (SBI) is an evidence-based practice for reducing at-risk drinking and alcohol-related risk behaviors. Health care reform sets the stage for a large expansion of SBI to individuals in the United States. Social workers have the opportunity to play an important role in helping establish SBI nationally, but they must become more involved in its delivery, educating new social workers with respect to SBI practice, and taking part in research to expand the field's knowledge of this service.
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Affiliation(s)
- Gerald Cochran
- Health Behavior Research and Training Institute, School of Social Work, The University of Texas at Austin, Austin, TX 78712, USA.
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Purshouse RC, Brennan A, Rafia R, Latimer NR, Archer RJ, Angus CR, Preston LR, Meier PS. Modelling the cost-effectiveness of alcohol screening and brief interventions in primary care in England. Alcohol Alcohol 2012; 48:180-8. [PMID: 23015608 DOI: 10.1093/alcalc/ags103] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To estimate the cost-effectiveness and resourcing implications of universal alcohol screening and brief intervention (SBI) programmes in primary care in England. METHODS This was a health economic model, combining evidence of the effectiveness and health care resource requirements of SBI activities with existing epidemiological modelling of the relationship between alcohol consumption and health harms. RESULTS Screening patients on registration with a family doctor would steadily capture ~40% of the population over a 10-year programme; screening patients at next primary care consultation would capture 96% of the population over the same period, but with high resourcing needs in the first year. The registration approach, delivered by a practice nurse, provides modest cost savings to the health care system of £120 m over 30 years. Health gains over the same period amount to 32,000 quality-adjusted life years (QALYs). This SBI programme still appears cost-effective (at £6900 per QALY gained) compared with no programme, under pessimistic effectiveness assumptions. Switching to a consultation approach, delivered by a doctor, would incur an incremental net cost of £108 m, with incremental health gains equivalent to 92,000 QALYs, giving an incremental cost-effectiveness ratio of £1175 per QALY gained compared with current practice. CONCLUSION A universal programme of alcohol SBI in primary care is estimated to be cost-effective, under all but the most pessimistic assumptions for programme costs and effectiveness. Policymakers should ensure that SBI programmes are routinely evaluated and followed up, given the substantial uncertainty over the effects of many of the implementation details.
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Affiliation(s)
- Robin C Purshouse
- Department of Automatic Control & Systems Engineering, University of Sheffield, Mappin Street, Sheffield S1 3JD, UK.
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O'Brien A, Leonard L, Deering D. Could an advance practice nurse improve detection of alcohol misuse in the emergency department? Int J Ment Health Nurs 2012; 21:340-8. [PMID: 22540263 DOI: 10.1111/j.1447-0349.2011.00797.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alcohol misuse is a prevalent problem in New Zealand society, and one that exacts a considerable cost in terms of health, social cohesion, and economic productivity. Despite the burden of alcohol misuse, screening, brief assessment, and interventions for alcohol problems are frequently poorly performed within general health services. In this paper we explore the response to alcohol problems in a New Zealand emergency department and discuss difficulties encountered in improving rates of detection by emergency department personnel. We report the results of a clinical audit of alcohol screening and brief assessment and a staff education programme designed to improve practice in this area, but which met with limited success. The potential role for an advanced practice nurse providing a clinical consultation and liaison service to the emergency department staff is explored. We argue that such a role has potential to reduce the health and social costs of alcohol misuse, and to meet the national policy objective of providing a treatment response to people with alcohol-related problems in contact with health services.
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Affiliation(s)
- Anthony O'Brien
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand.
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The cost of screening and brief intervention in employee assistance programs. J Behav Health Serv Res 2012; 39:55-67. [PMID: 21938602 DOI: 10.1007/s11414-011-9253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Few studies examine the costs of conducting screening and brief intervention (SBI) in settings outside health care. This study addresses this gap in knowledge by examining the employer-incurred costs of SBI in an employee assistance program (EAP) when delivered by counselors. Screening was self-administered as part of the intake paperwork, and the brief intervention (BI) was delivered during a regular counseling session. Training costs were $83 per counselor. The cost of a screen to the employer was $0.64; most of this cost comprised the cost of the time the client spent completing the screen. The cost of a BI was $2.52. The cost of SBI is lower than cost estimates of SBI conducted in a health care setting. The low costs for the current study suggest that only modest gains in outcomes would likely be needed to justify delivering SBI in an EAP setting.
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Navarro HJ, Shakeshaft A, Doran CM, Petrie DJ. The potential cost-effectiveness of general practitioner delivered brief intervention for alcohol misuse: evidence from rural Australia. Addict Behav 2011; 36:1191-8. [PMID: 21849233 DOI: 10.1016/j.addbeh.2011.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 05/17/2011] [Accepted: 07/20/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This paper aims to model General Practitioner (GP) delivered screening and brief intervention (BI), and to identify the costs per additional risky drinker who reduces alcohol consumption to low-risk levels, relative to current practice. METHOD A decision model and nine different scenarios were developed to assess outcomes and costs of GP-delivered screening and BI on the potential number of risky drinkers who reduce their alcohol consumption to low-risk levels in 10 rural communities in New South Wales, Australia. FINDINGS Based on evidence from current practice, approximately 19% of all risky drinkers visiting GPs annually would reduce alcohol consumption to low-risk levels, of which 0.7% would do so because of GP-delivered screening and BI. If rates of screening and BI are increased to 100%, 36% of these risky drinkers would reduce their drinking to low risk-levels. Alternatively, increments of 10% and 20% in GP-delivered screening and BI would reduce the proportion of risky drinkers by 2.1% and 4.2% respectively. The most cost-effective outcome per additional risky drinker reducing their drinking relative to current practice would be if all of these risky drinkers are screened alone with an ICER of AUD$197. CONCLUSION These findings indicate that increments in rates of screening and BI delivered by GPs can result in cost-effective reductions per additional risky drinkers reducing their drinking to low-risk levels, relative to current practice. They also imply that achieving substantial reductions in the prevalence of risky drinking in a community will require strategies other than opportunistic screening and BIs by GPs.
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McQueen J, Howe TE, Allan L, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011; 2011:CD005191. [PMID: 21833953 PMCID: PMC10600352 DOI: 10.1002/14651858.cd005191.pub3] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Brief interventions involve a time-limited intervention focusing on changing behaviour. They are often motivational in nature using counselling skills to encourage a reduction in alcohol consumption. OBJECTIVES To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. SEARCH STRATEGY We searched the Cochrane Drug and Alcohol Group Register of Trials (March 2011) the Cochrane Central Register of Controlled Trials (The Cochrane Library March 2011), MEDLINE January 1966-March 2011, CINAHL 1982-March 2011, EMBASE 1980-March 2011 and www.clinicaltrials.gov to April 2011 and performed some relevant handsearching. SELECTION CRITERIA All prospective randomised controlled trials and controlled clinical trials were eligible for inclusion. Participants were adults and adolescents (16 years or older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment and received brief interventions (of up to 3 sessions) compared to no or usual care. DATA COLLECTION AND ANALYSIS Three reviewers independently selected the studies and extracted data. Where appropriate random effects meta-analysis and sensitivity analysis were performed. MAIN RESULTS Forteen studies involving 4041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. Self reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD -0.26 (95% CI -0.50 to -0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour. AUTHORS' CONCLUSIONS The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics.
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Affiliation(s)
- Jean McQueen
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200, Renfield StreetGlasgowUKG2 3QB
| | - Tracey E Howe
- Glasgow City of ScienceGlasgow Caledonian UniversityGlasgowScotlandUKG4 0BA
| | - Linda Allan
- Southern General HospitalTherapy centreGlasgowUKG51 4TF
| | - Diane Mains
- Victoria InfirmaryOccupational Therapy DepartmentGlasgowUKG42 9TY
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Boase S, Kim Y, Craven A, Cohn S. Involving practice nurses in primary care research: the experience of multiple and competing demands. J Adv Nurs 2011; 68:590-9. [DOI: 10.1111/j.1365-2648.2011.05764.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, Burnand B, Heather N. The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug Alcohol Rev 2011; 28:301-23. [PMID: 19489992 DOI: 10.1111/j.1465-3362.2009.00071.x] [Citation(s) in RCA: 289] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ISSUES Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials. APPROACH A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted. KEY FINDINGS The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I(2) = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials. CONCLUSIONS Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
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Affiliation(s)
- Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict 2011; 20:343-56. [PMID: 21679266 DOI: 10.1111/j.1521-0391.2011.00143.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Brief physician interventions can reduce alcohol consumption. Physicians may not have the time to provide brief interventions, and it is unclear whether nonphysicians can do so effectively. We conducted a systematic review and meta-analysis to examine the efficacy of brief interventions by nonphysician clinicians for unhealthy alcohol use. We searched the English-language literature in MEDLINE and other databases covering the domains of alcohol problems, primary care, nonphysician, and brief interventions. Studies of brief interventions delivered at least in part by nonphysicians in primary care and examining drinking outcomes were included. Sensitivity analyses examined the effect of excluding studies that contributed disproportionately to the heterogeneity of results. Thirteen studies, conducted 1996-2008, met our criteria. Seven studies with a total of 2,633 patients were included in the meta-analysis. Nonphysician interventions were associated with 1.7 (95% confidence interval [CI]=-.03 to -3.5) fewer standard drinks per week than control conditions (p = .054). Excluding the one study that increased heterogeneity, the effect was smaller but reached statistical significance; nonphysician counseling was associated with 1.4 (95% CI = .3- 2.4) fewer standard drinks per week compared to control (p = .012). Nonphysician brief interventions are modestly effective at reducing drinking in primary care patients with unhealthy alcohol use.
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Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, Connecticut 06520–8093, USA.
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Nyamathi AM, Nandy K, Greengold B, Marfisee M, Khalilifard F, Cohen A, Leake B. Effectiveness of intervention on improvement of drug use among methadone maintained adults. J Addict Dis 2011; 30:6-16. [PMID: 21218306 DOI: 10.1080/10550887.2010.531669] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of three interventions (individual motivational interviewing, group motivational interviewing, or nurse-led hepatitis health promotion) in reducing drug use. A randomized, controlled trial was conducted with 256 methadone maintained moderate-to-heavy alcohol-using adults attending one of five MM outpatient clinics. Drug use in the overall sample was significantly reduced from baseline to 6-month follow-up, as assessed by a 30-day recall (p < 0.0001), with a trend apparent for 6-month recall (p = 0.09). The group and individual programs revealed significant decreases in drug use at the 30-day recall.
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Affiliation(s)
- Adeline M Nyamathi
- University of California, Los Angeles, School of Nursing, Room 2-250, Factor Building, Box 951720, Los Angeles, CA 90095-1702, USA.
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Saitz R. Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Rev 2011; 29:631-40. [PMID: 20973848 DOI: 10.1111/j.1465-3362.2010.00217.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ISSUES Although screening and brief intervention (BI) in the primary-care setting reduces unhealthy alcohol use, its efficacy among patients with dependence has not been established. This systematic review sought to determine whether evidence exists for BI efficacy among patients with alcohol dependence identified by screening in primary-care settings. APPROACH We included randomised controlled trials (RCTs) extracted from eight systematic reviews and electronic database searches published through September 2009. These RCTs compared outcomes among adults with unhealthy alcohol use identified by screening who received BI in a primary-care setting with those who received no intervention. KEY FINDINGS Sixteen RCTs, including 6839 patients, met the inclusion criteria. Of these, 14 excluded some or all persons with very heavy alcohol use or dependence; one in which 35% of 175 patients had dependence found no difference in an alcohol severity score between groups; and one in which 58% of 24 female patients had dependence showed no efficacy. CONCLUSION AND IMPLICATIONS Alcohol screening and BI has efficacy in primary care for patients with unhealthy alcohol use, but there is no evidence for efficacy among those with very heavy use or dependence. As alcohol screening identifies both dependent and non-dependent unhealthy use, the absence of evidence for the efficacy of BI among primary-care patients with screening-identified alcohol dependence raises questions regarding the efficiency of screening and BI, particularly in settings where dependence is common. The finding also highlights the need to develop new approaches to help such patients, particularly if screening and BI are to be disseminated widely.[Saitz R. Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking.
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Affiliation(s)
- Richard Saitz
- Boston University School of Medicine, Boston Medical Center, Boston 02118, USA.
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Cowell AJ, Bray JW, Mills MJ, Hinde JM. Conducting economic evaluations of screening and brief intervention for hazardous drinking: Methods and evidence to date for informing policy. Drug Alcohol Rev 2011; 29:623-30. [PMID: 20973847 DOI: 10.1111/j.1465-3362.2010.00238.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ISSUES Many policy review articles have concluded that alcohol screening and brief intervention (SBI) is both cost-effective and cost-beneficial. Yet a recent cost-effectiveness review for the United Kingdom's National Institute for Health and Clinical Excellence suggests that these conclusions may be premature. APPROACH This article offers a brief synopsis of the various types of economic analyses that may be applied to SBI, including cost analysis, cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis and other types of economic evaluation. A brief overview of methodological issues is provided, and examples from the SBI evaluation literature are provided. KEY FINDINGS, IMPLICATIONS AND CONCLUSIONS The current evidence base is insufficient to draw firm conclusions about the cost, cost-effectiveness or cost-benefit of SBI and about the impact of SBI on health-care utilisation.[Cowell AJ, Bray JW, Mills MJ, Hinde JM. Conducting economic evaluations of screening and brief intervention for hazardous drinking: Methods and evidence to date for informing policy.
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A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Med Care 2011; 49:287-94. [PMID: 21263359 DOI: 10.1097/mlr.0b013e318203624f] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis examines the effect of screening and brief intervention (SBI) on outpatient, emergency department (ED), and inpatient health care utilization outcomes. Much of the current literature speculates that SBI provides cost savings through reduced health care utilization, but no systematic review or meta-analysis examines this assertion. METHOD Publications were abstracted from online journal collections and targeted Web searches. The systematic review included any publications that examined the association between SBI and health care utilization. Each publication was rated independently by 2 study authors and assigned a consensus methodological score. The meta-analysis focused on those studies examined in the systematic review, but it excluded publications that had incomplete data, low methodological quality, or a cluster-randomized design. RESULTS Systematic review results suggest that SBI has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization. A random effects meta-analysis using the Hedges method confirms the ED result for SBI delivered across settings (standardized mean difference = -0.06, I = 13.9%) but does not achieve statistical significance (confidence interval: -0.15, 0.03). CONCLUSIONS SBI may reduce overall health care costs, but more studies are needed. Current evidence is inconclusive for SBI delivered in ED and non-ED hospital settings. Future studies of SBI and health care utilization should report the estimated effects and variance, regardless of the effect size or statistical significance.
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Bernstein JA, Bernstein E, Heeren TC. Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: implications for bias toward the null. Drug Alcohol Rev 2011; 29:498-507. [PMID: 20887573 DOI: 10.1111/j.1465-3362.2010.00174.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ISSUES Reductions in control group consumption over time that are possibly related to research design affect the impact of brief alcohol interventions (BAI) in clinical settings. APPROACH We conducted a systematic review to identify research design factors that may contribute to control group change, strategies to limit these effects and implications for researchers. Studies with control group n > 30 were selected if they published baseline and outcome consumption data, conducted trials in clinical settings in Anglophone countries and did not censor gender or age. KEY FINDINGS Among 38 studies cited in 20 reviews through October 2009, 16 met criteria (n = 31-370). In 54%, controls received alcohol specific handouts, advice and/or referral. Both the number and depth of assessments were highly variable. The percentage change in consumption ranged from-0.10 to-0.84 (mean-0.32), and effect size from 0.04 to 0.70 (mean 0.37). Published data were insufficient for meta-analysis. IMPLICATIONS Researchers should consider strategies to reduce the impact of research design factors, such as procedures to enhance sample diversity, blind subjects to study purpose to limit social desirability bias, reduce the number and depth of instruments (assessment reactivity), and finally, analytic techniques to decrease the impact of outliers and regression to the mean. CONCLUSIONS This review identifies problems with retrospective analysis of predictors of control group change, and underscores the need to design prospective studies to permit identification, quantification and adjustment for potential sources of bias in BAI trials.
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Affiliation(s)
- Judith A Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
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Nyamathi A, Tyler D, Sinha K, Marfisee M, Cohen A, Greengold B. Predictors of hepatitis knowledge improvement among methadone maintained clients enrolled in a hepatitis intervention program. J Community Health 2010; 35:423-32. [PMID: 20358265 PMCID: PMC2926441 DOI: 10.1007/s10900-010-9266-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This randomized, controlled study (n = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion, among clients undergoing methadone maintenance treatment (MMT) in Los Angeles and Santa Monica. The participants were randomized into three groups: Motivational Interviewing-Single Session (MI-Single), Motivational Interviewing-Group (MI-Group), or Nurse-Led Hepatitis Health Promotion (HHP). All three treatment groups received the 3-series HAV/HBV vaccine. The MI sessions were provided by trained therapists, the Nurse-Led HHP sessions were delivered by a research nurse. The main outcome variable of interest was improvement in HBV and HCV knowledge, measured by a 6-item HBV and a 7-item HCV knowledge and attitude tool that was administered at baseline and at 6-month follow-up. The study results showed that there was a significant increase in HBV- and HCV-related knowledge across all three groups (p < 0.0001). There were no significant differences found with respect to knowledge acquisition among the groups. Irrespective of treatment group, gender (P = 0.008), study site (P < 0.0001) and whether a participant was abused as a child (P = 0.017) were all found to be predictors of HCV knowledge improvement; only recruitment site (P < 0.0001) was found to be a predictor of HBV knowledge. The authors concluded that, although MI-Single, MI-Group and Nurse-Led HHP are all effective in promoting HBV and HCV knowledge acquisition among MMT clients, Nurse-Led HHP may be the method of choice for this population as it may be easier to integrate and with additional investigation may prove to be more cost efficient.
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Affiliation(s)
- Adeline Nyamathi
- UCLA, School of Nursing, 700 Tiverton Avenue, Los Angeles, CA 90095-1702, USA.
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Noknoy S, Rangsin R, Saengcharnchai P, Tantibhaedhyangkul U, McCambridge J. RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol Alcohol 2010; 45:263-70. [PMID: 20236990 DOI: 10.1093/alcalc/agq013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand. METHODS A randomized controlled trial was conducted in eight PCUs in Ubonratchatanee and Chachoengsao provinces in Thailand. Hazardous drinkers were identified using the World Health Organization-recommended Alcohol Use Disorder Identification Test. Of 117 eligible participants (91% male), 59 were randomized to the intervention group to receive MET in three individual appointments with a trained nurse and 58 to an assessment-only control group. Outcome evaluations were carried out after 6 weeks, 3 months and 6 months. RESULTS Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group (P < 0.05) after both 3 and 6 months. The groups did not generally differ at 6 weeks. However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study. CONCLUSION MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.
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Affiliation(s)
- Sairat Noknoy
- Department of Social Medicine, Chonburi Hospital and Medical Education Center, Chonburi, 20000, Thailand.
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Effect of motivational interviewing on reduction of alcohol use. Drug Alcohol Depend 2010; 107:23-30. [PMID: 19836904 PMCID: PMC3383096 DOI: 10.1016/j.drugalcdep.2009.08.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 08/14/2009] [Accepted: 08/19/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population. OBJECTIVE To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use. METHODS A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions (n=87); (2) MI delivered in group sessions (MI-group; n=79), or (3) MI delivered one-on-one sessions (MI-single, n=90). RESULTS Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p<.05). In multiple logistic regression analysis controlling for alcohol consumption at baseline and other covariates, no differences by condition were found. DISCUSSION As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.
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Barbosa C, Godfrey C, Parrott S. Methodological assessment of economic evaluations of alcohol treatment: what is missing? Alcohol Alcohol 2009; 45:53-63. [PMID: 19808943 DOI: 10.1093/alcalc/agp067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study is to review the methodology that has been adopted in previous economic evaluations of alcohol treatment and offer research recommendations with a view to enhancing the consistency and harmonization of economic evaluations in the alcohol field. METHODS Published full economic evaluations of alcohol treatment were retrieved using a systematic search. The studies were analysed in terms of the identification, measurement and valuation methods used to assess the society-level consequences and the methods used to carry out the analysis of individual-level consequences and costs of the intervention. A taxonomy of alcohol-related consequences was developed and used as a framework for the methodology extraction. RESULTS Twenty- seven studies were selected. Almost half of the studies did not include society-level consequences in their analysis. Some consequences of alcohol treatment at a societal level, such as the impact of treatment on health-related quality of life of family and friends of the drinker, have never been considered in the economic analysis. There was no agreement regarding the individual health consequences used in the evaluations. Measures capturing life years and morbidity have not been extensively used in the alcohol field. The level of reporting treatment costs on the reviewed studies is generally well detailed. CONCLUSION The literature is still rather sparse in this area and further research is required to fulfil the gaps. If a common methodology is adopted in future economic evaluations of alcohol treatment, more stable cost-effectiveness estimates will be produced and informed decisions for resources allocation to alcohol treatments will be possible.
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Affiliation(s)
- Carolina Barbosa
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK.
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Ashton H, Nodiyal A, Green D, Moore B, Heather N. Acupuncture or counselling: outcomes and predictors of treatment choice in a non‐statutory addiction service. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890802659002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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