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Oldroyd C, Greenham O, Martin G, Allison M, Notley C. Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol-associated hepatitis. Aliment Pharmacol Ther 2023; 58:763-773. [PMID: 37602505 DOI: 10.1111/apt.17665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Alcohol use is the most important factor in determining the prognosis of patients with alcohol-related cirrhosis and alcohol-associated hepatitis. AIM To conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol-associated hepatitis. METHODS We searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non-randomised studies. Risk of bias was assessed using validated tools. Where possible, meta-analysis was performed. RESULTS Twenty-three studies met the inclusion criteria including six randomised trials and 17 non-randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4-16.1). Three non-randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta-analysis of non-randomised studies that examined the impact of psychological therapies revealed statistically non-significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38-9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12-1.77). CONCLUSIONS Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non-randomised studies also point to non-pharmaceutical interventions possibly improving clinical outcomes.
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Affiliation(s)
- Christopher Oldroyd
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivia Greenham
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham Martin
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Michael Allison
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caitlin Notley
- Addiction Research Group, University of East Anglia, Norwich, UK
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Ruben JP, Paul V, Nicholas AV, Devarbhavi H, Patil M, Selvam S, Mysore. V A. Nurse-conducted Brief Intervention for Alcohol Use Disorders in a Medical In-patient Setting in India - A Feasibility Study. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1901633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Vanila Paul
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
| | | | - Harshad Devarbhavi
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics & Population Health, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Ashok Mysore. V
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
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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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Abstract
This paper provides an overview of brief intervention (BI) research to date and discusses future research needs as well as strategies for more widespread use of BI. Research has firmly established that significant reductions in drinking can be achieved by BI in a variety of health care settings. Despite convincing evidence, however, diffusion of BI in routine health care has been slow. Alcohol is a complex subject since it is often used moderately, without side-effects, and in a socially acceptable way. Although research on BI has accumulated rapidly during the last three decades, many important research challenges and development work remain before BI is widely implemented in routine health care.
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Affiliation(s)
- Per Nilsen
- Dep. of Social Medicine and Public Health Lindköping university, Sweden
| | - Eileen Kaner
- Inst. of Health & Society, Newcastle university, UK
| | - Thomas F. Babor
- Dep. of Community Medicine and Health Care University of Connecticut Health Center, Farmington, Connecticut, USA
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McQueen J, Allan L, Mains D. Brief Motivational Counselling for Alcohol Abusers Admitted to Medical Wards. Br J Occup Ther 2016. [DOI: 10.1177/030802260606900705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the United Kingdom the number of individuals abusing alcohol is continuing to increase. Alcohol abuse is linked with long-term health problems, with the potential to have an impact on work, relationships and the ability to function in daily life. Occupational therapists working within general hospital environments have regular contact with alcohol abusers, although there is limited evidence of effective interventions in this clinical setting. This article reports on a feasibility study, which investigated the potential role for occupational therapists in delivering brief motivational counselling to alcohol abusers admitted to medical wards. Consideration is given to the practicality of delivering such an intervention. The outcome measures used were the Fast Alcohol Screening Tool (FAST), self-reported alcohol consumption and participant's rationale for change. A small sample of 40 participants was recruited. Although the results presented are not statistically significant, this feasibility study will be important in assisting clinicians to plan future research in this area.
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Brief Interventions for Harmful Alcohol Use in Opioid-dependent Patients on Maintenance Treatment With Buprenorphine: A Prospective Study From India. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Owens L, Kolamunnage-Dona R, Owens A, Perkins L, Butcher G, Wilson K, Beale S, Mahon J, Williamson P, Gilmore I, Pirmohamed M. A Randomized Controlled Trial of Extended Brief Intervention for Alcohol-Dependent Patients in an Acute Hospital Setting. Alcohol Alcohol 2016; 51:584-92. [DOI: 10.1093/alcalc/agw023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/03/2016] [Indexed: 11/14/2022] Open
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Schwarz AS, Bilberg R, Bjerregaard L, Nielsen B, Søgaard J, Nielsen AS. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial. BMC Health Serv Res 2016; 16:132. [PMID: 27080865 PMCID: PMC4832463 DOI: 10.1186/s12913-016-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model. Method/Design The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used. Discussion We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures. Trial registration https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)
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Affiliation(s)
- Anne-Sophie Schwarz
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Bilberg
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lene Bjerregaard
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jes Søgaard
- The Danish Cancer Society and Aarhus University, Faculty of Health Science, Institute of Clinical Medicine, Department of Clinical Epidemiology, Copenhagen, Denmark
| | - Anette Søgaard Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Pivetti M, Scattino F, Dattola A, Gioga G. Long-Term Abstinence and Quality of Life After a Socioecological Treatment Program: An Italian Experience. ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1113107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Campbell-Scherer D, Saitz R. Improving reporting and utility of evaluations of complex interventions. EVIDENCE-BASED MEDICINE 2015; 21:1-3. [PMID: 26608477 DOI: 10.1136/ebmed-2015-110342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Richard Saitz
- Section of General Internal Medicine, Boston University & Boston Medical Center, Boston, Massachusetts, USA Editorial Office, BMJ Group, London, UK
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Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015; 110:1404-15. [PMID: 25913697 PMCID: PMC4753046 DOI: 10.1111/add.12950] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
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Affiliation(s)
- Joseph E. Glass
- School of Social Work, University of Wisconsin-Madison, Madison, WI
| | | | - Byron J. Powell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian E. Perron
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Randall T. Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews. Prev Med 2015; 76 Suppl:S33-8. [PMID: 25514547 DOI: 10.1016/j.ypmed.2014.12.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of brief interventions in the primary health care setting to decrease alcohol consumption in non-alcoholic adult drinkers. METHOD Systematic review of systematic reviews and meta-analyses of randomized clinical trials published in English and Spanish and indexed in EMBASE, MEDLINE (PubMed), Web of Science, Scopus, and The Cochrane Library, from their inception to January 2014. The quality of the studies was evaluated with the AMSTAR instrument. RESULTS Seven studies, published from 1999 to 2011, were included in the review (six meta-analyses, one systematic review). These studies were heterogeneous in terms of design, type and length of interventions analyzed, participants, responsible professionals, and results. Five studies reported a moderate decrease in alcohol consumption and four showed a decrease in the number of participants who consumed alcohol above the established risk level. CONCLUSION Brief interventions have a moderate effect on reducing alcohol consumption among excessive drinkers or people who consume excessive amounts of alcohol and as a consequence these interventions increased the number of people drinking alcohol below established limits of risk. Brief interventions with multiple contacts or follow-up sessions are the most effective.
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Tønnesen H, Egholm JW, Oppedal K, Lauritzen JB, Madsen BL, Pedersen B. Patient education for alcohol cessation intervention at the time of acute fracture surgery: study protocol for a randomised clinical multi-centre trial on a gold standard programme (Scand-Ankle). BMC Surg 2015; 15:52. [PMID: 25925742 PMCID: PMC4422327 DOI: 10.1186/s12893-015-0035-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness. METHODS/DESIGN Patients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point. DISCUSSION The study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike. TRIAL REGISTRATION The protocol is registered in ClinicalTrials.gov (Id: NCT00986791 ).
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Affiliation(s)
- Hanne Tønnesen
- />WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- />Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Julie Weber Egholm
- />WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- />Orthopedic Department, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark
| | - Kristian Oppedal
- />Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Jes Bruun Lauritzen
- />Department of Orthopaedic Surgery, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Lindegård Madsen
- />Department of Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Pedersen
- />WHO-CC, Clinical Health Promotion Centre, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- />Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Simioni N, Cottencin O, Rolland B. Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients with Alcohol Use Disorders from Somatic Inpatient Settings: A Systematic Review. Alcohol Alcohol 2015; 50:420-9. [DOI: 10.1093/alcalc/agv017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
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Ito C, Yuzuriha T, Noda T, Ojima T, Hiro H, Higuchi S. Brief Intervention in the Workplace for Heavy Drinkers: A Randomized Clinical Trial in Japan. Alcohol Alcohol 2014; 50:157-63. [DOI: 10.1093/alcalc/agu090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Alcohol-related dementia (ARD) is a controversial concept. Alcohol-related brain damage (ARBD) is a term used to cover a spectrum of conditions and disorders: this includes alcohol-related dementia, Korsakoff's syndrome, Wernicke's encephalopathy, alcohol-related brain injury, and alcohol amnesic syndrome. In other words, these are the conditions that have been induced by chronic alcohol consumption, resulting in some degree of brain damage. The prevalence data are varied.
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Gaume J, Magill M, Longabaugh R, Bertholet N, Gmel G, Daeppen JB. Influence of counselor characteristics and behaviors on the efficacy of a brief motivational intervention for heavy drinking in young men--a randomized controlled trial. Alcohol Clin Exp Res 2014; 38:2138-47. [PMID: 24961378 DOI: 10.1111/acer.12469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/26/2014] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brief motivational intervention (BMI) has shown promising results to reduce alcohol use in young adults. Knowledge on mechanisms that predict BMI efficacy could potentially improve treatment effect sizes through data that optimize clinical training and implementation. Particularly, little attention has been given to counselor influence on treatment mechanisms. METHODS We investigated the influence of counselors on BMI efficacy in reducing alcohol use among non-treatment-seeking young men (age 20) screened as hazardous drinkers. Participants were randomly allocated to (i) a group receiving a single BMI from 1 of 18 counselors selected to maximize differences in several of their characteristics (gender, professional status, clinical experience, and motivational interviewing [MI] experience) or (ii) a control group receiving assessment only. Drinking at 3-month follow-up was first compared between the BMI and control groups to assess efficacy. Then, the influence of counselors' characteristics (i.e., gender, professional status, clinical experience, MI experience, BMI attitudes, and expectancies) and within-session behaviors (i.e., measured by the Motivational Interviewing Skill Code) on outcome was tested in regression analyses. RESULTS There was a significant (p = 0.02) decrease in alcohol use among the BMI group compared to the control group. Counselors that were male, more experienced, that had more favorable BMI attitudes and expectancies, higher MI skills, but surprisingly less MI-consistent behaviors, had significantly better outcomes than the control group while their counterparts did not. CONCLUSIONS The current study demonstrated BMI efficacy on alcohol use reduction within a sample of non-treatment-seeking young adult males. Moreover, BMI effect was related to interindividual differences among counselors, and results therefore provide recommendations for BMI training and implementation with similar populations.
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Affiliation(s)
- Jacques Gaume
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island; Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland
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A multisite randomized controlled trial of brief intervention to reduce drinking in the trauma care setting: how brief is brief? Ann Surg 2014; 259:873-80. [PMID: 24263324 DOI: 10.1097/sla.0000000000000339] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Determine the efficacy of 3 brief intervention strategies that address heavy drinking among injured patients. BACKGROUND The content or structure of brief interventions most effective at reducing alcohol misuse after traumatic injury is not known. METHODS Injured patients from 3 trauma centers were screened for heavy drinking and randomly assigned to brief advice (n = 200), brief motivational intervention (BMI) (n = 203), or BMI plus a telephone booster using personalized feedback or BMI + B (n = 193). Among those randomly assigned, 57% met criteria for moderate to severe alcohol problems. The primary drinking outcomes were assessed at 3, 6, and 12 months. RESULTS Compared with brief advice and BMI, BMI + B showed significant reductions in the number of standard drinks consumed per week at 3 (Δ adjusted means: -1.22, 95% confidence interval [CI]: -0.99, approximately -1.49, P = 0.01) and 6 months (Δ adjusted means: -1.42, 95% CI: -1.14, approximately -1.76, P = 0.02), percent days of heavy drinking at 6 months (Δ adjusted means: -5.90, 95% CI: -11.40, approximately -0.40, P = 0.04), maximum number of standard drinks consumed in 1 day at 3 (Δ adjusted means: -1.38, 95% CI: -1.18, approximately -1.62, P = 0.003) and 12 months (Δ adjusted means: -1.71, 95% CI: -1.47, approximately -1.99, P = 0.02), and number of standard drinks consumed per drinking day at 3 (Δ adjusted means: -1.49, 95% CI: -1.35, approximately -1.65, P = 0.002) and 6 months (Δ adjusted means: -1.28, 95% CI: -1.17, approximately -1.40, P = 0.01). CONCLUSIONS Brief interventions based on motivational interviewing with a telephone booster using personalized feedback were most effective at achieving reductions in alcohol intake across the 3 trauma centers.
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van den Wijngaart LS, Sieben A, van der Vlugt M, de Leeuw FE, Bredie SJH. A Nurse-Led Multidisciplinary Intervention to Improve Cardiovascular Disease Profile of Patients. West J Nurs Res 2014; 37:705-23. [DOI: 10.1177/0193945914533427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of this study was to evaluate the impact of a structured screening and nurse-based intervention on cardiovascular risk factors. In patients with established cardiovascular disease, a cardiovascular risk profile was assessed, and lifestyle was evaluated by using an automated questionnaire. A multidisciplinary team proposed an integral individualized plan of care on the basis of these assessments. During follow-up, a nurse-led lifestyle intervention program and the best medical treatment were offered. A total of 328 outpatients were included. After screening, a follow-up term of at least 1 year was reached in 176 patients (59.9%). Low-density lipoprotein cholesterol and systolic blood pressure were significantly reduced. A reduction in the amount of smoking, alcohol consumption, and unhealthy eating habits was observed. However, the amount of physical activity was unaffected, and body mass was increased. A structural evaluation of cardiovascular risk factors and an integrated nurse-led approach can successfully reduce risk in cardiovascular patients.
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Affiliation(s)
- L. S. van den Wijngaart
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, The Netherlands
| | - A. Sieben
- Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands
| | - M. van der Vlugt
- Department of Cardiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - F. E. de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - S. J. H. Bredie
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, The Netherlands
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Shiles CJ, Canning UP, Kennell-Webb SA, Gunstone CM, Marshall EJ, Peters TJ, Wessely SC. Randomised controlled trial of a brief alcohol intervention in a general hospital setting. Trials 2013; 14:345. [PMID: 24148799 PMCID: PMC4016505 DOI: 10.1186/1745-6215-14-345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background The evidence suggests that brief alcohol-focused interventions, directed at hazardous and harmful drinkers in non-specialist settings such as primary care are effective in reducing alcohol consumption. However, there is a need for further research in the hospital setting. This is a randomised controlled trial to investigate the effectiveness of a 10-minute brief intervention amongst 'at risk’ drinkers admitted to general hospital wards. Unlike some previous trials, this trial is randomised, used blinded assessors, includes an intention-to-treat analysis, included female subjects and excluded people with alcohol dependence. Methods A total of 250 'at risk’ drinkers admitted to King’s College Hospital were identified using the Alcohol Use Disorders Identification Test (AUDIT). Some 154 subjects entered the study and were randomly allocated to the control and intervention groups. Subjects in the control group received no advice about their drinking whilst subjects in the intervention group received 10 minutes of simple advice on reducing alcohol consumption. Recruitment took place between 1995 and 1997. The primary outcome was the AUDIT questionnaire at 12 months. Secondary outcomes were a previous week’s Drinks Diary, questionnaires (General Health Questionnaire, Alcohol Problems Questionnaire and the Severity of Alcohol Dependence Questionnaire) and laboratory blood tests (gamma glutamyl transferase, mean cell volume and haemoglobin). Results At 3-month and 12-month follow-up, all participants were included in the intention-to-treat analysis. At both time points there was no evidence of an intervention effect that could be attributed to the brief intervention. Both the intervention and control groups had an improved AUDIT score and reduced levels of alcohol consumption as measured by a subjective Drinks Diary at 3 months which was maintained at 12 months. Conclusions This study has added further evidence on brief interventions in the hospital setting. In contrast to the recent Cochrane review by McQueen et al., the results of this study do not support the effectiveness of a brief alcohol intervention in general hospital wards. However our study was underpowered and there were flaws in the statistical analyses, and these limitations temper the strength of our conclusions.
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Affiliation(s)
| | | | | | | | - E Jane Marshall
- Out-Patient Department, Maudsley Hospital, South London and Maudsley, NHS Foundation Trust, Alcohol Unit, C/O Room 40, Denmark Hill, London SE5 8AZ, UK.
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Crombie IK, Falconer DW, Irvine L, Williams B, Ricketts IW, Humphris G, Norrie J, Rice P, Slane PW. Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractBackgroundSocially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.Objectives(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.DesignA three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.SettingCommunity-based study, conducted in Dundee, UK.ParticipantsDisadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.InterventionsFocus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.Main outcome measuresThe outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.ResultsThe focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.ConclusionsThis study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.Study registrationThis study is registered as ISRCTN10515845.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- IK Crombie
- School of Medicine, University of Dundee, Dundee, UK
| | - DW Falconer
- School of Medicine, University of Dundee, Dundee, UK
| | - L Irvine
- School of Medicine, University of Dundee, Dundee, UK
| | - B Williams
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - IW Ricketts
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - P Rice
- NHS Substance Abuse Services, Stracathro Hospital, Brechin, UK
| | - PW Slane
- The Erskine Practice, Arthurstone Medical Centre, Dundee, UK
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Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: results from a randomized controlled trial. BMC Public Health 2013; 13:644. [PMID: 23844552 PMCID: PMC3849548 DOI: 10.1186/1471-2458-13-644] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background High prevalence rates of hazardous and harmful alcohol use have been found in a hospital outpatient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake among hospital outpatients in South Africa. Methods The study design for this effectiveness study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous or harmful drinkers in a hospital setting. Outpatients were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counselling session on alcohol risk reduction, while the control group received a health education leaflet. Results Of the 1419 screened for alcohol misuse who agreed to participate in the trial 392 (27.6%) screened positive for hazardous or harmful use on the Alcohol Use Disorder Identification Test (AUDIT) (score 7/8-19) and 51 (3.6%) had an AUDIT score of 20 or more. Among the 282 (72%) hospital outpatients who also attended the 12-month follow-up session, the time effects on the AUDIT scores were significant [F (1,195 = 7.72), P < 0.01] but the intervention effect on the AUDIT score was statistically not significant [F (1,194 = 0.06), P < 0.804]. Conclusion Given the lack of difference in outcome between control and intervention group, alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking. Trial registration PACTR201110000319392
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Mdege ND, Fayter D, Watson JM, Stirk L, Sowden A, Godfrey C. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend 2013; 131:1-22. [PMID: 23474201 DOI: 10.1016/j.drugalcdep.2013.01.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing interest in pro-active detection and provision of interventions for heavy alcohol use in the general hospital inpatient population. We aimed to determine, from the available evidence, the effectiveness of interventions in reducing alcohol consumption among general hospital inpatient heavy alcohol users. METHODS The following databases were searched for completed and on-going randomised and non-randomised controlled studies published up to November 2012: MEDLINE; C2-SPECTR; CINAHL; The Cochrane Library; Conference Proceedings Citation Index: Science; EMBASE; HMIC; PsycInfo; Public Health Interventions Cost Effectiveness Database (PHICED); and ClinicalTrials.gov. Studies were screened independently by two reviewers. Data extraction was performed by one reviewer and independently checked by a second. RESULTS Twenty-two studies which met the inclusion criteria enrolled 5307 participants in total. All interventions were non-pharmacological and alcohol focused. Results from single session brief interventions and self-help literature showed no clear benefit on alcohol consumption outcomes, with indications of benefit from some studies but not others. However, results suggest brief interventions of more than one session could be beneficial on reducing alcohol consumption, especially for non-dependent patients. No active intervention was found superior over another on alcohol consumption and other outcomes. CONCLUSIONS Brief interventions of more than one session could be beneficial on reducing alcohol consumption among hospital inpatients, especially for non-dependent patients. However, additional evidence is still needed before more definitive conclusions can be reached.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, Heslington, York, UK.
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Abstract
BACKGROUND Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. METHODS Changes in second and third questions with theoretical simulation of possible answers' combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. RESULTS Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. CONCLUSIONS Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor-patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.
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Affiliation(s)
- Marko Kolšek
- Department of Family Medicine, Medical Faculty, University of Ljubljana , Ljubljana, SVN , Slovenia.
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Jørgensen CC, Kehlet H. Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand 2013; 57:631-8. [PMID: 23421518 DOI: 10.1111/aas.12086] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking and alcohol use impair post-operative outcomes. However, no studies include fast-track surgery, which is a multimodal-enhanced recovery programme demonstrated to improve outcome. We hypothesised that outcome is similar in smokers and alcohol users as in non-users after fast-track hip and knee arthroplasty. METHODS Prospective questionnaires on co-morbidity and smoking/alcohol use were cross-referenced with the Danish National Health Registry to investigate relationship between smoking/alcohol use and length of stay of > 4 days and readmissions ≤ 90 days after fast-track hip and knee arthroplasty. RESULTS In 3041 consecutive patients, 458 reported smoking and 216 drinking > 2 drinks a day, of which 66 did both. Smokers/alcohol users were younger than non-users (mean age: 64.3 vs. 68.0 years, P < 0.001). Multiple regression analysis showed no relation between length of stay of > 4 days and smoking (odds ratio [95% confidence interval], P) (1.34 [0.92-1.95], 0.127) or alcohol use (0.59 [0.30-1.16], 0.127). Thirty- and ninety-day readmission rate was 6.6% (n = 201) and 9.4% (n = 285). Multiple logistic regression analysis showed an increased risk of readmissions in smokers at 30 (1.60 [1.05-2.44], 0.028) but not 90-day follow-up (1.17 [0.80-1.73], 0.419). No increased risk of readmissions was found in alcohol users at 30 (0.94 [0.50-1.76], 0.838) or 90-day follow-up (0.83 [0.47-1.49], 0.532). No increased risk of specific readmissions (i.e. wound infections or pneumonia) typically related to smoking/alcohol use was found in smokers (1.56 [0.93-2.62], 0.091) or alcohol users (1.00 [0.47-2.15], 0.999) at 90-day follow-up. CONCLUSION Influence of smoking or alcohol use may be less pronounced in fast-track hip and knee arthroplasty compared with data with conventional care programmes.
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Affiliation(s)
- C C Jørgensen
- Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
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Watson JM, Fayter D, Mdege N, Stirk L, Sowden AJ, Godfrey C. Interventions for alcohol and drug problems in outpatient settings: A systematic review. Drug Alcohol Rev 2013; 32:356-67. [DOI: 10.1111/dar.12037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/08/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - Debra Fayter
- Centre for Reviews and Dissemination; University of York; York; UK
| | - Noreen Mdege
- Department of Health Sciences; University of York; York; UK
| | - Lisa Stirk
- Centre for Reviews and Dissemination; University of York; York; UK
| | - Amanda J. Sowden
- Centre for Reviews and Dissemination; University of York; York; UK
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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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Watson RR, Preedy VR, Zibadi S. Alcohol, HIV/AIDS, and Liver Disease. ALCOHOL, NUTRITION, AND HEALTH CONSEQUENCES 2013. [PMCID: PMC7122083 DOI: 10.1007/978-1-62703-047-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Globally, there are over 33 million persons living with HIV/AIDS resulting in 1.8 million deaths annually. While the rate of HIV transmission is slowing, it is estimated that 2.6 million new infections occur yearly [1]. In the United States, there are approximately 1.2 million living with HIV/AIDS, with 50,000 new HIV infections and 17,000 deaths from the disease annually [2]. For those who can obtain effective antiretroviral therapy (ART), HIV/AIDS has become a chronic disease with life expectancies over 30 years [3]. Research in the last 10 years has revealed the importance of alcohol in the HIV/AIDS epidemic. Alcohol use, in moderate or hazardous amounts, has been associated with increased acquisition of HIV infection, progression of HIV infection, deleterious effects on HIV treatment, and acceleration in the comorbidities of HIV infection [4–9]. Yet alcohol remains the “forgotten drug” of the HIV/AIDS epidemic [10].
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Affiliation(s)
- Ronald Ross Watson
- Arizona Health Science Center, Mel and Enid Zuckerman College of Public, University of Arizona, 1501 N. Campbell Ave. ROOM 4335, TUCSON, 85724-5155 Arizona USA
| | - Victor R. Preedy
- Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH United Kingdom
| | - Sherma Zibadi
- Division of Health Promotion Sciences, Mel and Enid Zuckerman, University of Arizona, 1295 N. Martin Avenue, Tucson, 85724 Arizona USA
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Krupski A, Joesch JM, Dunn C, Donovan D, Bumgardner K, Lord SP, Ries R, Roy-Byrne P. Testing the effects of brief intervention in primary care for problem drug use in a randomized controlled trial: rationale, design, and methods. Addict Sci Clin Pract 2012; 7:27. [PMID: 23237456 PMCID: PMC3598998 DOI: 10.1186/1940-0640-7-27] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial body of research has established the effectiveness of brief interventions for problem alcohol use. Following these studies, national dissemination projects of screening, brief intervention (BI), and referral to treatment (SBIRT) for alcohol and drugs have been implemented on a widespread scale in multiple states despite little existing evidence for the impact of BI on drug use for non-treatment seekers. This article describes the design of a study testing the impact of SBIRT on individuals with drug problems, its contributions to the existing literature, and its potential to inform drug policy. METHODS/DESIGN The study is a randomized controlled trial of an SBIRT intervention carried out in a primary care setting within a safety net system of care. Approximately 1,000 individuals presenting for scheduled medical care at one of seven designated primary care clinics who endorse problematic drug use when screened are randomized in a 1:1 ratio to BI versus enhanced care as usual (ECAU). Individuals in both groups are reassessed at 3, 6, 9, and 12 months after baseline. Self-reported drug use and other psychosocial measures collected at each data point are supplemented by urine analysis and public health-related data from administrative databases. DISCUSSION This study will contribute to the existing literature by providing evidence for the impact of BI on problem drug use based on a broad range of measures including self-reported drug use, urine analysis, admission to drug abuse treatment, and changes in utilization and costs of health care services, arrests, and death with the intent of informing policy and program planning for problem drug use at the local, state, and national levels. TRIAL REGISTRATION ClinicalTrials.gov NCT00877331.
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Affiliation(s)
- Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
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Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med 2012; 4:123-30. [PMID: 20936079 DOI: 10.1097/adm.0b013e3181db6b67] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.
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Holt SR, Ramos J, Harma M, Cabrera F, Louis-Ashby C, Dinh A, Fiellin DA, Tetrault JM. Physician detection of unhealthy substance use on inpatient teaching and hospitalist medical services. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 39:121-9. [PMID: 22992028 DOI: 10.3109/00952990.2012.715703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment for substance use depends on reliable identification. The goal of this study was to determine the rate of detection of unhealthy substance use by physicians on teaching and nonteaching medical services at a community teaching hospital. METHODS This cross-sectional study was conducted from February to June 2009. All new medicine admissions to the Teaching Service or the nonteaching Hospitalist Service were assessed for unhealthy substance use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Drug Abuse Screening Test (DAST). All patients identified with substance use completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Medical record review was also performed to assess physician documentation. RESULTS Of 442 eligible patients, 414 consented to participate. Patients on the Teaching Service were more likely to be male, younger, unmarried, non-white, uninsured or receiving publicly funded insurance, and current smokers (p < .01 for all comparisons). Overall, the detection rate for unhealthy substance use was 64.3% (63 of 98 confirmed cases), with service-specific rates of 73.4% for the Teaching Service, compared with 47.1% for the Hospitalist Service (p = .011). ICD-9 coding accounted for 53.1% of identified cases on the Teaching Service and 14.7% of identified cases on the Hospitalist Service (p < .001). Assignment to the Hospitalist Service, being married, and isolated unhealthy drug use were independently associated with decreased physician detection rates. CONCLUSIONS Our study suggests that unhealthy substance use is more likely to be detected on a Teaching Service than on a Hospitalist Service.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
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Fachini A, Aliane PP, Martinez EZ, Furtado EF. Efficacy of brief alcohol screening intervention for college students (BASICS): a meta-analysis of randomized controlled trials. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:40. [PMID: 22967716 PMCID: PMC3499225 DOI: 10.1186/1747-597x-7-40] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/03/2012] [Indexed: 11/18/2022]
Abstract
Background Many studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences. Methods A systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated. Results 18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median = 212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means = −1.50 drinks per week, 95% CI: -3.24 to −0.29) and alcohol-related problems (difference between means = −0.87, 95% CI: -1.58 to −0.20) compared to controls. Conclusions Overall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.
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Affiliation(s)
- Alexandre Fachini
- Department of Neurosciences and Behavior, University of Sao Paulo, Av, dos Bandeirantes, 3900-3° andar, Monte Alegre, Ribeirão Preto, SP 14048-900, Brazil.
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Bischof G, Freyer-Adam J, Meyer C, John U, Rumpf HJ. Changes in drinking behavior among control group participants in early intervention studies targeting unhealthy alcohol use recruited in general hospitals and general practices. Drug Alcohol Depend 2012; 125:81-8. [PMID: 22516146 DOI: 10.1016/j.drugalcdep.2012.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 03/22/2012] [Accepted: 03/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aims to analyze the influence of setting variables on drinking behavior in patients with unhealthy alcohol consumption recruited proactively in general medical practices (GP) and internal and surgical wards of two general hospitals (GH) assigned to control groups. METHOD This analysis compared two control groups of RCTs targeting unhealthy alcohol consumption: one outpatient sample (GP; n=99) with one inpatient sample (GH; n=173). Both groups were recruited via systematic screening of all patients aged between 18 and 64 years and were included in the studies if drank above the at-risk criteria of the British Medical Association (20/30 g alcohol/daily) and/or fulfilled criteria of alcohol abuse or - dependence according to DSM-IV. Both samples received a non-alcohol specific brochure on healthy living after study inclusion and were re-assessed 12 months later. RESULTS GH patients were significantly older, included of more males, had received less schooling and had a higher readiness to change at baseline than GP patients. Groups did not differ concerning alcohol-related diagnoses or smoking status. At the 12-month follow-up, significantly more GH patients revealed abstinence or drinking below the inclusion criteria (50.0% vs. 26.1%, p<.001). In a multivariate analysis, medical setting (GH vs. GP) remained a significant predictor for non-problematic drinking or abstinence even after controlling for baseline differences between groups. CONCLUSIONS Findings suggest that untreated change from problematic alcohol use may be more intense after non-alcohol-related inpatient treatment than after having been a GP patient. Implications for brief interventions in inpatients are discussed.
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Affiliation(s)
- G Bischof
- Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
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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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Abstract
ISSUES This article traces the history of research on the development, evaluation and implementation of alcohol brief intervention (BI) in Europe. APPROACH Narrative and historical review. KEY FINDINGS BI originated in Europe and, following a definition of opportunistic BI, early pioneering studies are summarised. The role of European scientists in the series of studies making up the WHO Collaborative Project on Detection and Management of Alcohol-related Problems in Primary Health Care (1982-2006) is then described, followed by a short account of a current EU-funded project (Primary Health European Project on Alcohol) with the aim of achieving a widespread, routine and enduring implementation of BI in EU member states. In addition to involvement in these two major projects, a great deal of research on BI has been carried out in a range of European countries and some of this research is noted. IMPLICATIONS Several European governments are now taking the rolling out of BI in routine services very seriously as a policy measure. There is no necessary conflict between widely available BI and alcohol control measures. CONCLUSION While much remains to be done regarding practical implementation, the mood of those interested in the promotion of BI as a means of reducing alcohol-related harm, in Europe as elsewhere, is cautiously optimistic.
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Affiliation(s)
- Nick Heather
- Department of Psychology, School of Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
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Pengpid S, Peltzer K, Skaal L, van der Heever H, Van Hal G. Screening and brief intervention for alcohol problems in Dr George Mukhari Hospital out-patients in Gauteng, South Africa: a single-blinded randomized controlled trial protocol. BMC Public Health 2012; 12:127. [PMID: 22333738 PMCID: PMC3297501 DOI: 10.1186/1471-2458-12-127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background For alcohol drinkers in South Africa it has been found that annual consumption per drinker is among the highest in the world. High prevalence rates of hazardous and harmful alcohol use have also been found in a hospital out-patient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the efficacy of brief interventions in reducing alcohol intake among hospital out-patients in South Africa. Methods/Design The study design for this efficacy study is a randomised controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by problem drinkers in a hospital setting. The unit of randomisation is the individual out-patient identified as a medium risk drinker attending Dr George Mukhari Hospital. Out-patients will be screened for alcohol problems, and those identified as medium risk drinkers will be randomized into an experimental or control group. The experimental group will receive one brief counselling session on alcohol risk reduction, while the control group will receive a health education leaflet. Discussion The trial will evaluate the impact of alcohol screening and brief interventions for patients with alcohol problems in a hospital out-patient setting in South Africa. The findings will impact public health and will enable the health ministry to formulate policy related to brief alcohol interventions, which will result in reduction in alcohol use. Trial registration PACTR201110000319392
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Affiliation(s)
- Supa Pengpid
- Department of Health System Management and Policy, University of Limpopo (MEDUNSA Campus), Pretoria, South Africa.
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Screening instruments for detecting illicit drug use/abuse that could be useful in general hospital wards: a systematic review. Addict Behav 2011; 36:1111-9. [PMID: 21821364 DOI: 10.1016/j.addbeh.2011.07.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 04/15/2011] [Accepted: 07/12/2011] [Indexed: 11/23/2022]
Abstract
AIM To identify and describe screening instruments for detecting illicit drug use/abuse that are appropriate for use in general hospital wards and review evidence for reliability, validity, feasibility and acceptability. METHODS Instruments were identified from a number of screening instrument databases/libraries and Google Scholar. They were independently assessed for eligibility by two reviewers. MEDLINE, EMBASE, PSYCINFO, and Cochrane Library were searched for articles published up to February 2010. Two reviewers independently assessed the identified articles for eligibility and extracted data from the eligible studies. RESULTS 13 instruments, ASSIST, CAGE-AID, DAST, DHQ/PDHQ, DUDIT, DUS, NMASSIST, SIP-AD, SDS, SMAST-AID, SSI-SA, TICS and UNCOPE were included in the review. They had 2 to 28 items and took less than 10 min to administer and score. Evidence on validity, reliability, acceptability and feasibility of instruments in adult patients not known to have a substance abuse problem was scarce. Of the 21 studies included in the review, only one included participants from general hospital wards. Reported sensitivity, specificity and predictive values varied widely both between studies of the same instrument and also between different instruments. No study was identified comparing two or more of the included instruments. CONCLUSION The review identified and described 13 instruments that could be useful in general hospital wards. There is however lack of evaluation of illicit drug use screening instruments in general hospital wards. Currently clinicians or researchers searching for a simple, reliable, general screening instrument for current drug use to guide practice or research in general hospital wards do not have enough comparative evidence to choose between the available measures.
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Clark BJ, Smart A, House R, Douglas I, Burnham EL, Moss M. Severity of acute illness is associated with baseline readiness to change in medical intensive care unit patients with unhealthy alcohol use. Alcohol Clin Exp Res 2011; 36:544-51. [PMID: 21950704 DOI: 10.1111/j.1530-0277.2011.01648.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unhealthy alcohol use predisposes to multiple conditions that frequently result in critical illness and is present in up to one-third of patients admitted to a medical intensive care unit (ICU). We sought to determine the baseline readiness to change in medical ICU patients with unhealthy alcohol use and hypothesized that the severity of acute illness would be independently associated with higher scores on readiness to change scales. We further sought to determine whether this effect is modified by the severity of unhealthy alcohol use. METHODS We performed a cross-sectional observational study of current regular drinkers in 3 medical ICUs. The Alcohol Use Disorders Identification Test was used to differentiate low-risk and unhealthy alcohol use and further categorize patients into risky alcohol use or an alcohol use disorder. The severity of a patient's acute illness was assessed by calculating the Acute Physiologic and Chronic Health Evaluation II (APACHE II) score at the time of admission to the medical ICU. Readiness to change was assessed using standardized questionnaires. RESULTS Of 101 medical ICU patients who were enrolled, 65 met the criteria for unhealthy alcohol use. The association between the severity of acute illness and readiness to change depended on the instrument used. A higher severity of illness measured by APACHE II score was an independent predictor of readiness to change as assessed by the Stages of Change Readiness and Treatment Eagerness Scale (Taking Action scale; p < 0.01). When a visual analog scale was used to assess readiness to change, there was a significant association with severity of acute illness (p < 0.01) that was modified by the severity of unhealthy alcohol use (p = 0.04 for interaction term). CONCLUSIONS Medical ICU patients represent a population where brief interventions require further study. Studies of brief intervention should account for the severity of acute illness and the severity of unhealthy alcohol use as potential effect modifiers.
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Affiliation(s)
- Brendan J Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, Colorado 80045, USA.
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Pedersen B, Oppedal K, Egund L, Tønnesen H. Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC Surg 2011. [PMID: 21943382 DOI: 10.1186/1471-2482-11-26]available] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. METHODS A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. RESULTS The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months.Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients.The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. CONCLUSIONS Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.
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Affiliation(s)
- Bolette Pedersen
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals and Health Services, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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Pedersen B, Oppedal K, Egund L, Tønnesen H. Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC Surg 2011; 11:26. [PMID: 21943382 PMCID: PMC3189859 DOI: 10.1186/1471-2482-11-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 09/23/2011] [Indexed: 12/03/2022] Open
Abstract
Background In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. Methods A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. Results The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months. Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients. The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. Conclusions Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.
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Affiliation(s)
- Bolette Pedersen
- WHO Collaborating Centre for Evidence-based Health Promotion in Hospitals and Health Services, Bispebjerg University Hospital, Copenhagen NV, Denmark.
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Darker CD, Sweeney BP, El Hassan HO, Smyth BP, Ivers JHH, Barry JM. Brief interventions are effective in reducing alcohol consumption in opiate-dependent methadone-maintained patients: results from an implementation study. Drug Alcohol Rev 2011; 31:348-56. [PMID: 21919978 DOI: 10.1111/j.1465-3362.2011.00349.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND AIMS An implementation study to test the feasibility and effectiveness of brief interventions (BIs) to reduce hazardous and harmful alcohol consumption in opiate-dependent methadone-maintained patients. DESIGN AND METHODS Before and after intervention comparison of Alcohol Use Disorders Identification Test (AUDIT-C) scores from baseline to 3month follow up. Seven hundred and ten (82%) of the 863 eligible methadone-maintained patients within three urban addiction treatment clinics were screened. A World Health Organization protocol for a clinician-delivered single BI to reduce alcohol consumption was delivered. The full AUDIT questionnaire was used at baseline (T1) to measure alcohol consumption and related harms; and in part as a screening tool to exclude those who may be alcohol-dependent. AUDIT-C was used at 3month follow up (T2) to assess any changes in alcohol consumption. RESULTS. One hundred and sixty (23% of overall sample screened) 'AUDIT-positive' cases were identified at baseline screening with a mean total full AUDIT score of 13.5 (SD 6.7). There was a statistically significant reduction in AUDIT-C scores from T1 ( , SD=2.35) to T2 (, SD=2.66) for the BI group (z=-3.98, P<0.01). There was a statistically significant decrease in the proportion of men who were AUDIT-positive from T1 to T2 (χ(2) =8.25, P<0.003). DISCUSSION AND CONCLUSIONS It is feasible for a range of clinicians to screen for problem alcohol use and deliver BI within community methadone clinics. Opiate-dependent patients significantly reduced their alcohol consumption as a result of receiving a BI.
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Affiliation(s)
- Catherine D Darker
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.
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Secondary prevention in the intensive care unit: does intensive care unit admission represent a "teachable moment?". Crit Care Med 2011; 39:1500-6. [PMID: 21494113 DOI: 10.1097/ccm.0b013e31821858bb] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Cigarette smoking and unhealthy alcohol use are common causes of preventable morbidity and mortality that frequently result in admission to an intensive care unit. Understanding how to identify and intervene in these conditions is important because critical illness may provide a "teachable moment." Furthermore, the Joint Commission recently proposed screening and receipt of an intervention for tobacco use and unhealthy alcohol use as candidate performance measures for all hospitalized patients. Understanding the efficacy of these interventions may help drive evidence-based institution of programs, if deemed appropriate. DATA SOURCES A summary of the published medical literature on interventions for unhealthy alcohol use and smoking obtained through a PubMed search. SUMMARY Interventions focusing on behavioral counseling for cigarette smoking in hospitalized patients have been extensively studied. Several studies include or focus on critically ill patients. The evidence demonstrates that behavioral counseling leads to increased rates of smoking cessation but the effect depends on the intensity of the intervention. The identification of unhealthy alcohol use can lead to brief interventions. These interventions are particularly effective in trauma patients with unhealthy alcohol use. However, the current literature would not support routine delivery of brief interventions for unhealthy alcohol use in the medical intensive care unit population. CONCLUSIONS Intensive care unit admission represents a "teachable moment" for smokers and some patients with unhealthy alcohol use. Future studies should assess the efficacy of brief interventions for unhealthy alcohol use in medical intensive care unit patients. In addition, identification of the timing and optimal individual to conduct the intervention will be necessary.
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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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Owens L, Butcher G, Gilmore I, Kolamunnage-Dona R, Oyee J, Perkins L, Walley T, Williamson P, Wilson K, Pirmohamed M. A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC). BMC Public Health 2011; 11:528. [PMID: 21726445 PMCID: PMC3141470 DOI: 10.1186/1471-2458-11-528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 12/03/2022] Open
Abstract
Background Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments. Methods/Design This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI) delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN) will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED) of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ) score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT) score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods. Discussion This paper presents a protocol for a RCT of EBI delivered to alcohol dependent patients by an ASN within an ED. Importantly; the trial will also seek to understand patients' perceptions and experiences of being part of a RCT and of receiving this form of intervention. Trial registration number ISRCTN: ISRCTN78062794
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Affiliation(s)
- Lynn Owens
- The Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
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Prevalence of alcohol use and associated factors in urban hospital outpatients in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2629-39. [PMID: 21845149 PMCID: PMC3155320 DOI: 10.3390/ijerph8072629] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6%) consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT). Two in five patients (40.5%) were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.
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Cobain K, Owens L, Kolamunnage-Dona R, Fitzgerald R, Gilmore I, Pirmohamed M. Brief Interventions in Dependent Drinkers: A Comparative Prospective Analysis in Two Hospitals. Alcohol Alcohol 2011; 46:434-40. [DOI: 10.1093/alcalc/agr044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu SI, Wu SI, Chen SC, Huang HC, Sun FJ, Fang CK, Hsu CC, Huang CR, Yeh HM, Shih SC. Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men. Addiction 2011; 106:928-40. [PMID: 21205050 DOI: 10.1111/j.1360-0443.2010.03330.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. DESIGN Randomized controlled trial. SETTING Medical/surgical wards of a medical centre in Taipei, Taiwan. PARTICIPANTS Of 3669 consecutive adult male in-patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). MEASUREMENTS Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self-reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7-day time-line follow-back. Secondary outcomes were (i) self-reported alcohol problems, (ii) health-care utilization (hospital days and emergency department visits), (iii) self-reported seeking of speciality treatment for alcohol problems and (iv) 3-month Quick Drinking Screen. FINDINGS Based on intention-to-treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol-dependent participants over 12 months, on both 7-day and 3-month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol-related problems and health-care utilization did not differ significantly in the two groups during follow-up. CONCLUSIONS Data from Taiwan confirm that brief in-hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.
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Affiliation(s)
- Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
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McPherson A, Benson G. The development and explication of a unique nurse‐led addiction liaison service for the acute hospitals in the Greater Glasgow area. DRUGS AND ALCOHOL TODAY 2011. [DOI: 10.5042/daat.2011.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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