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Staton CA, Agnihotri D, Phillips AJ, Ngowi K, Huo L, Boshe J, Sakita F, Tupetz A, Suffoletto B, Mmbaga BT, Vissoci JRN. Development of culturally-appropriate text message booster content to follow a brief intervention focused on reducing alcohol related harms for injury patients in Moshi, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002717. [PMID: 39052647 PMCID: PMC11271911 DOI: 10.1371/journal.pgph.0002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
Alcohol use is a risk factor for death and disability and is attributed to almost one-third of injury deaths globally. This highlights the need for interventions aimed at alcohol reduction, especially in areas with high rates of injury with concurrent alcohol use, such as Tanzania. The aim of this study is to create a culturally appropriate text messages as a booster to a brief negotiational intervention (BNI), to in the Emergency Department of the Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Creation of text message boosters for an ED-based intervention expands the window of opportunity for alcohol use reduction in this high-risk population. The study followed a two-step approach to create the text message content in English and then translate and culturally adapt to Tanzanian Swahili. The culturalization process followed the World Health Organization's process of translation and adaptation of instruments. Translation, back translation, and qualitative focus groups were used for quality control to ensure text message content accuracy and cultural appropriateness. In total, nearly 50 text messages were initially developed in English, yet only 29 text messages were successfully translated and adapted; they were focused on the themes of Self-awareness, Goal setting and Motivation. We developed culturally appropriate text message boosters in Swahili for injury patients in Tanzania coupled with a BNI for alcohol use reduction. We found it important to evaluate content validation for interventions and measurement tools because the intended text message can often be lost in translation. The process of culturalization is critical in order to create interventions that are applicable and beneficial to the target population. Trial registration: Clinical Trials Registration Number: NCT02828267, NCT04535011.
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Affiliation(s)
- Catherine A. Staton
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Deepti Agnihotri
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Lily Huo
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
| | - Judith Boshe
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Medical University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University, Palo Alto, California, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Medical University College, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
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Chan PSF, Fang Y, Xie YJ, Wong MCS, Nilsen P, Leung SF, Cheung K, Wang Z, Yeoh EK. Applying the Consolidated Framework for Implementation Research to investigate factors of implementing alcohol screening and brief intervention among primary care physicians and nurses in Hong Kong, China: an exploratory sequential mixed-method study. Implement Sci Commun 2024; 5:52. [PMID: 38711156 PMCID: PMC11071187 DOI: 10.1186/s43058-024-00590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. METHODS This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. RESULTS The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. CONCLUSIONS There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.
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Affiliation(s)
- Paul Shing-Fong Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Martin Chi-Sang Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sau-Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Staton CA, Friedman K, Phillips AJ, Minnig MC, Sakita FM, Ngowi KM, Suffoletto B, Hirshon JM, Swahn M, Mmbaga BT, Vissoci JRN. Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania. PLoS One 2023; 18:e0288458. [PMID: 37535693 PMCID: PMC10399826 DOI: 10.1371/journal.pone.0288458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention. MATERIALS AND METHODS This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster. RESULTS Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible. CONCLUSIONS Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country. TRIAL REGISTRATION Trial registration number NCT02828267. https://classic.clinicaltrials.gov/ct2/show/NCT02828267.
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Affiliation(s)
- Catherine A. Staton
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Ashley J. Phillips
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | | | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittbsurgh, PA, United States of America
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore MD, United States of America
| | - Monica Swahn
- Department of Epidemiology, Georgia State University School of Public Health, Atlanta, GA, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
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Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
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Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
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Staton CA, Vissoci JRN, El-Gabri D, Adewumi K, Concepcion T, Elliott SA, Evans DR, Galson SW, Pate CT, Reynolds LM, Sanchez NA, Sutton AE, Yuan C, Pauley A, Andrade L, Von Isenberg M, Ye JJ, Gerardo CJ. Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary. PLoS Med 2022; 19:e1003961. [PMID: 35413054 PMCID: PMC9004752 DOI: 10.1371/journal.pmed.1003961] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. METHODS AND FINDINGS In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. CONCLUSIONS Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. TRIAL REGISTRATION Protocol Registry: PROSPERO CRD42017055549.
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Affiliation(s)
- Catherine A. Staton
- Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Health Sciences Graduate Program, State University of Maringa, Maringa, Parana State, Brazil
| | - João Ricardo Nickenig Vissoci
- Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Health Sciences Graduate Program, State University of Maringa, Maringa, Parana State, Brazil
| | - Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Konyinsope Adewumi
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Shannon A. Elliott
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Daniel R. Evans
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Sophie W. Galson
- Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Charles T. Pate
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Lindy M. Reynolds
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nadine A. Sanchez
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Alexandra E. Sutton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
| | - Charlotte Yuan
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Alena Pauley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Luciano Andrade
- Health Sciences Graduate Program, State University of Maringa, Maringa, Parana State, Brazil
| | - Megan Von Isenberg
- Duke School of Medical Center Library Services & Archives, Duke University, Durham, North Carolina, United States of America
| | - Jinny J. Ye
- Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Tanner-Smith EE, Parr NJ, Schweer-Collins M, Saitz R. Effects of brief substance use interventions delivered in general medical settings: a systematic review and meta-analysis. Addiction 2022; 117:877-889. [PMID: 34647649 PMCID: PMC8904275 DOI: 10.1111/add.15674] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023]
Abstract
AIMS To estimate effects of brief substance use interventions delivered in general medical settings. METHODS A systematic review and meta-analysis of randomized trials conducted since 1990 of brief substance use interventions in patients of any age or severity level recruited in general medical settings. Primary outcomes were any measure of substance use or substance-related consequences (indexed with Hedges' g and risk ratios). Mixed-effects meta-regressions were used to estimate overall effects and predictors of effect variability. Analyses were conducted separately by brief intervention (BI) target substance: alcohol only or drugs. FINDINGS A total of 116 trials (64 439 participants) were identified; 111 (62 263 participants) provided effect size data and were included in the meta-analysis. Drug-targeted BIs yielded significant small improvements in multiple drug/mixed substance use (Hedges' g (g¯ ) = 0.08; 95% CI = 0.002, 0.15), but after adjusting for multiple comparisons, they did not produce significant effects on cannabis use ( g¯ = 0.06; 95% CI = 0.001, 0.12), alcohol use ( g¯ = 0.08; 95% CI = -0.0003, 0.17), or consequences ( g¯ = 0.05; 95% CI = 0.01, 0.10). Drug-targeted BIs yielded larger improvements in multiple drug/mixed substance use when delivered by a general practitioner ( g¯ = 0.19; 95% CI = 0.187, 0.193). Alcohol-targeted BIs yielded small beneficial effects on alcohol use ( g¯ = 0.12; 95% CI 0.08, 0.16), but no evidence of an effect on consequences ( g¯ = 0.05; 95% CI = -0.04, 0.13). However, alcohol-targeted BIs only had beneficial effects on alcohol use when delivered in general medical settings (g¯ = 0.17; 95% CI = 0.10, 0.24); the findings were inconclusive for those delivered in emergency department/trauma centers ( g¯ = 0.05; 95% CI = 0.00, 0.10). CONCLUSIONS When delivered in general medical settings, alcohol-targeted brief interventions may produce small beneficial reductions in drinking (equivalent to a reduction in 1 drinking day per month). There is limited evidence regarding the effects of drug-targeted brief interventions on drug use.
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Affiliation(s)
- Emily E. Tanner-Smith
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215
| | - Nicholas J. Parr
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215,U.S. Department of Veterans Affairs Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239
| | - Maria Schweer-Collins
- University of Oregon, Counseling Psychology and Human Services Department, College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4 Floor, Boston, MA 02118,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine; Grayken Center for Addiction, Boston Medical Center
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Sunami T, Kawai M, Sakurai J, Shirasaka T, Tezuka Y, Nagamine H, Maesato H, Yumoto Y, Yoshimoto H, Adachi Y, Yuzuriha T. [Introduction of a support program for reducing alcohol consumption that can be applied immediately in the workplace]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2021; 63:324-328. [PMID: 33390365 DOI: 10.1539/sangyoeisei.2020-044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Takashi Sunami
- Local Incorporated Administrative Agency Saga-Ken Medical Centre Koseikan
| | | | | | | | | | | | - Hitoshi Maesato
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Yosuke Yumoto
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Hisashi Yoshimoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba
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Barbosa C, Bray JW, Dowd WN, Barnosky A, Wittenberg E. SF-6D utility scores for alcohol use disorder status and alcohol consumption risk levels in the US population. Addiction 2021; 116:1034-1042. [PMID: 33448504 PMCID: PMC7882636 DOI: 10.1111/add.15224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/26/2020] [Accepted: 08/07/2020] [Indexed: 01/12/2023]
Abstract
AIMS To estimate US population health utilities for subgroups defined by alcohol use disorder (AUD) status and consumption level. DESIGN Cross-sectional survey. SETTING Community settings in the United States (i.e. excluding institutional settings). PARTICIPANTS A total of 36,042 adults (age 18+) in non-institutional settings in the United States. MEASUREMENTS We used 12-item Short Form Survey (SF-12) data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to calculate mean Short Form-6 dimension (SF-6D) utility scores across World Health Organization alcohol consumption risk levels-very high risk, high risk, medium risk, low risk and an additional abstinent level-for three groups: (1) the general population (n = 36,042), (2) individuals with life-time AUD (n = 9925) and (3) individuals with current AUD (n = 5083), and assessed minimally important differences (MIDs) between consumption levels. Each group is a subset of the previous group. FINDINGS The general population's mean SF-6D utility was higher than that of individuals with life-time or current AUD across all consumption risk levels (0.79 versus 0.76 for both AUD groups). For all groups, SF-6D utilities increased as consumption risk level decreased to non-abstinent levels, and reducing consumption from very high risk to any lower level was associated with a statistically significant and meaningful improvement in utility. For individuals with life-time or current AUD, becoming abstinent from high-, medium- and low-risk levels was associated with significantly and meaningfully worse utilities. CONCLUSIONS Higher alcohol consumption risk levels appear to be associated with lower health index scores for the general population and individuals with a history of alcohol use disorder, meaning that higher alcohol consumption is associated with worse health-related quality of life.
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Affiliation(s)
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina, Greensboro, NC, USA
| | | | | | - Eve Wittenberg
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nystrand C, Gebreslassie M, Ssegonja R, Feldman I, Sampaio F. A systematic review of economic evaluations of public health interventions targeting alcohol, tobacco, illicit drug use and problematic gambling: Using a case study to assess transferability. Health Policy 2021; 125:54-74. [PMID: 33069504 DOI: 10.1016/j.healthpol.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Abstract
AIMS To identify and assess the cost-effectiveness of public health interventions targeting the use of alcohol, illicit drugs and tobacco, as well as problematic gambling behavior (ANDTS), and consider whether the results from these evaluations are transferable to the Swedish setting. METHODS A systematic review of economic evaluations within the area of ANDTS was conducted including studies published between January 2000 and November 2018, identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the possibilities of transferring results were assessed using criteria set out by the Swedish Agency for Health Technology Assessment. RESULTS Out of 54 relevant studies, 39 were of moderate to high quality and included in the review, however none for problematic gambling. Eighty-one out of a total of 91 interventions were cost-effective. The interventions largely focusing on taxed-based policies or screening and brief interventions. Thirteen of these studies were deemed to have high potential for transferability, with effect estimates considered relevant, and with good feasibility for implementation in Sweden. CONCLUSIONS Interventions targeting alcohol- and illicit-drug use and tobacco use are cost-effective approaches, and results may be transferred to the Swedish setting. Caution must be taken regarding cost estimates and the quality of the evidence which the studies are based upon.
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Affiliation(s)
- Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
| | - Mihretab Gebreslassie
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
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10
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Castro-Jiménez RA, Fonseca del Pozo FJ, Jiménez Moral G, Fruet-Cardozo JV. Analysis of health habits, vices and interpersonal relationships of Spanish adolescents, using SEM statistical model. Heliyon 2020; 6:e04699. [PMID: 32904217 PMCID: PMC7452389 DOI: 10.1016/j.heliyon.2020.e04699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022] Open
Abstract
The objective of this article is to know the state of health of a sample of adolescents and how it relates to toxic habits and personal relationships. Likewise, it is presented how can influence eating habits, sports practice and interpersonal relationships in their general health status. The research has carried out through a survey of 56 questions to 470 adolescents, between 13 and 18 years old, of both sexes, of different schools in the province of Cordoba, Spain. These results have been subjected to a statistical model widely used in health and social sciences in general, called Structural Equations Model (SEM), through the SPSS program, v. 23 and AMOS. SEM is widely used in the social sciences to estimate regression models (usually multi-equational). The estimated model shows a significant global acceptability based on the usual statistical tests and goodness-of-fit measures. In this regard, these results are: CMIN = 17.554 with 33 degrees of freedom (DF) and a probability level, p = 0.987, which is higher than any reasonable level of significance (α = 0.05, 0.10, even 0.20). Likewise, FMIN = 0.038, CFI = 1.000 and RMSEA = 0.000. The main recommendation of this research aimed at improving good eating and healthy habits, and to avoid toxic habits of adolescents, is to begin the education in the family, in coordination with their school and high school.
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Affiliation(s)
| | | | | | - J. Vicente Fruet-Cardozo
- Department of Statistics, Econometrics, Operations Research, Business Organization and Applied Economics, University of Cordoba, Spain
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11
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Abidi L, Nilsen P, Karlsson N, Skagerström J, O'Donnell A. Conversations about alcohol in healthcare - cross-sectional surveys in the Netherlands and Sweden. BMC Public Health 2020; 20:283. [PMID: 32131793 PMCID: PMC7057588 DOI: 10.1186/s12889-020-8367-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated and compared the extent, duration, contents, experiences and effects of alcohol conversations in healthcare in the Netherlands and Sweden in 2017. Methods Survey data in the Netherlands and Sweden were collected through an online web panel. Subjects were 2996 participants (response rate: 50.8%) in Sweden and 2173 (response rate: 82.2%) in the Netherlands. Data was collected on socio-demographics, alcohol consumption, healthcare visits in the past 12 months, number of alcohol conversations, and characteristics of alcohol conversations (duration, contents, experience, effects). Results Results showed that Swedish respondents were more likely to have had alcohol conversations (OR = 1.99; 95%CI = 1.64–2.41; p = < 0.001) compared to Dutch respondents. In Sweden, alcohol conversations were more often perceived as routine (p = < 0.001), were longer (p = < 0.001), and more often contained verbal information about alcohol’s health effects (p = 0.007) or written information (p = 0.001) than in the Netherlands. In Sweden, 40+ year-olds were less likely to report a positive effect compared to the youngest respondents. In the Netherlands, men, sick-listed respondents, and risky drinkers, and in Sweden those that reported “other” occupational status such as parental leave, were more likely to have had alcohol conversations. Conclusions The results suggest that alcohol conversations are more common in healthcare practice in Sweden than in the Netherlands. However, positive effects of alcohol conversations were less likely to be reported among older respondents in Sweden. Our results indicate that alcohol preventative work should be improved in both countries, with more focus on risky drinkers and the content of the conversations in Sweden, and expanding alcohol screening in the Netherlands.
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Affiliation(s)
- Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Limburg, Netherlands.
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nadine Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Janna Skagerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Research and Development Unit of Region Östergötland, Region Östergötland, Linköping, Sweden
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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12
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Bardach AE, Alcaraz AO, Ciapponi A, Garay OU, Riviere AP, Palacios A, Cremonte M, Augustovski F. Alcohol consumption's attributable disease burden and cost-effectiveness of targeted public health interventions: a systematic review of mathematical models. BMC Public Health 2019; 19:1378. [PMID: 31655600 PMCID: PMC6815367 DOI: 10.1186/s12889-019-7771-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background Around 6% of total deaths are related to alcohol consumption worldwide. Mathematical models are important tools to estimate disease burden and to assess the cost-effectiveness of interventions to address this burden. Methods We carried out a systematic review on models, searching main health literature databases up to July 2017. Pairs of reviewers independently selected, extracted data and assessed the quality of the included studies. Discrepancies were resolved by consensus. We selected those models exploring: a) disease burden (main metrics being attributable deaths, disability-adjusted life years, quality-adjusted life years) or b) economic evaluations of health interventions or policies, based on models including the aforementioned outcomes. We grouped models into broad families according to their common central methodological approach. Results Out of 4295 reports identified, 63 met our inclusion criteria and were categorized in three main model families that were described in detail: 1) State transition -i.e Markov- models, 2) Life Table-based models and 3) Attributable fraction-based models. Most studies pertained to the latter one (n = 29, 48.3%). A few miscellaneous models could not be framed into these families. Conclusions Our findings can be useful for future researchers and decision makers planning to undertake alcohol-related disease burden or cost-effectiveness studies. We found several different families of models. Countries interested in adopting relevant public health measures may choose or adapt the one deemed most convenient, based on the availability of existing data at the local level, burden of work, and public health and economic outcomes of interest.
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Affiliation(s)
- Ariel Esteban Bardach
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Andrea Olga Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Osvaldo Ulises Garay
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Andrés Pichón Riviere
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alfredo Palacios
- Center for Study of State and Society (CEDES), Sánchez de Bustamante 27 (C1173AAA) CABA, Buenos Aires, Argentina
| | - Mariana Cremonte
- Group of Psychoactive Substances and injuries due to external cause, Institute of Basic, Applied Psychology and Technology (IPSIBAT) CONICET National University of Mar del Plata, Dean Funes 3250, B7602AYJ, Mar del Plata, Buenos Aires, Argentina
| | - Federico Augustovski
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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13
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Angus C, Li J, Romero-Rodriguez E, Anderson P, Parrott S, Brennan A. Cost-effectiveness of strategies to improve delivery of brief interventions for heavy drinking in primary care: results from the ODHIN trial. Eur J Public Health 2018; 29:219-225. [DOI: 10.1093/eurpub/cky181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Esperanza Romero-Rodriguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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14
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Palacio-Vieira J, Segura L, Anderson P, Wolstenholme A, Drummond C, Bendtsen P, Wojnar M, Kaner E, Keurhorst MN, van Steenkiste B, Kłoda K, Mierzecki A, Parkinson K, Newbury-Birch D, Okulicz-Kozaryn K, Deluca P, Colom J, Gual A. Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C. J Eval Clin Pract 2018; 24:369-374. [PMID: 29194899 DOI: 10.1111/jep.12854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVE The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. METHOD From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. RESULTS Thirty-two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR = 0.56; 95% CI, 0.31-0.99; P < .05). CONCLUSION Although the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.
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Affiliation(s)
- J Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - L Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - P Anderson
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - A Wolstenholme
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - C Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - P Bendtsen
- Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - E Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - M N Keurhorst
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - B van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - K Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - A Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - K Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - K Okulicz-Kozaryn
- State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland
| | - P Deluca
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - J Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - A Gual
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,Red de Trastornos Adictivos (RETICS), Instituto Carlos III, Madrid, Spain
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15
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O’Donnell A, Abidi L, Brown J, Karlsson N, Nilsen P, Roback K, Skagerström J, Thomas K. Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England. BMC Public Health 2018; 18:391. [PMID: 29562901 PMCID: PMC5863360 DOI: 10.1186/s12889-018-5275-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite robust evidence for their effectiveness, it has proven difficult to translate alcohol prevention activities into routine health care practice. Previous research has identified numerous provider-level barriers affecting implementation, but these have been less extensively investigated in the wider population. We sought to: (1) investigate patients' beliefs and attitudes to being asked about alcohol consumption in health care; and (2) identify the characteristics of those who are supportive of addressing alcohol consumption in health care. METHODS Cross-sectional household interviews conducted as part of the national Alcohol Toolkit Study in England between March and April 2017. Data were collected on age, gender, social grade, drinking category, and beliefs and attitudes to being asked about alcohol in routine health care. Unadjusted and multivariate-adjusted logistic regression models were performed to investigate associations between socio-demographic characteristics and drinking category with being "pro-routine" (i.e. 'agree completely' that alcohol consumption should be routinely addressed in health care) or "pro-personal" (i.e. 'agree completely' that alcohol is a personal matter and not something health care providers should ask about). RESULTS Data were collected on 3499 participants, of whom 50% were "pro-routine" and 10% were "pro-personal". Those in social grade C1, C2, D and E were significantly less likely than those in AB of being "pro-routine". Women were less likely than men to be "pro-personal", and those aged 35-44 or 65 years plus more likely to be "pro-personal" compared with participants aged 16-24. Respondents aged 65 plus were twice as likely as those aged 16-24 to agree completely that alcohol consumption is a personal matter and not something health care providers should ask about (OR 2.00, 95% CI 1.34-2.99). CONCLUSIONS Most adults in England agree that health care providers should routinely ask about patients' alcohol consumption. However, older adults and those in lower socio-economic groups are less supportive. Drinking status appears to have limited impact on whether people believe that alcohol is a personal matter and not something health care providers should ask about. REGISTRATION Open Science Framework ( https://osf.io/xn2st/ ).
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Affiliation(s)
- Amy O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Latifa Abidi
- Department of Health Promotion, Maastricht University, Maastricht, Limburg Netherlands
| | - Jamie Brown
- Research Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine Karlsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Kerstin Roback
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Janna Skagerström
- Research and Development Unit, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medical and Health Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
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16
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Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:689-99. [PMID: 27167074 PMCID: PMC4938847 DOI: 10.1007/s11121-016-0653-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.
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Hunter R, Wallace P, Struzzo P, Vedova RD, Scafuri F, Tersar C, Lygidakis C, McGregor R, Scafato E, Freemantle N. Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis. BMJ Open 2017; 7:e014577. [PMID: 29102983 PMCID: PMC5722092 DOI: 10.1136/bmjopen-2016-014577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 08/23/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI). DESIGN Randomised 1:1 non-inferiority trial. SETTING Practices of 58 general practitioners (GPs) in Italy. PARTICIPANTS Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial. INTERVENTIONS Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months. RESULTS The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI -0.007 to 0.011). CONCLUSIONS Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking. TRIAL REGISTRATION NUMBER NCT01638338;Post-results.
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Affiliation(s)
- Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London, London, UK
| | - Pierluigi Struzzo
- Regional Centre for Training in Primary Care, Monfalcone, Gorizia, Italy
- CSeRMEG, Centro Studi e Ricerche in Medicina Generale, Udine, Friuli Venzia Giulia, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Roberto Della Vedova
- CSeRMEG, Centro Studi e Ricerche in Medicina Generale, Udine, Friuli Venzia Giulia, Italy
| | - Francesca Scafuri
- Regional Centre for Training in Primary Care, Monfalcone, Gorizia, Italy
| | - Costanza Tersar
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Charilaos Lygidakis
- Research Unit INSIDE, Institute for Health and Behaviour, Université du Luxembourg, Luxembourg, Luxembourg
| | | | - Emanuele Scafato
- Istituto Superiore di Sanità,, WHO Collaborating Centre for Research and Health Promotion on Alcohol and Alcohol-Related Health Problems, Roma, Lazio, Italy
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
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18
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Angus C, Thomas C, Anderson P, Meier PS, Brennan A. Estimating the cost-effectiveness of brief interventions for heavy drinking in primary health care across Europe. Eur J Public Health 2017; 27:345-351. [PMID: 27558943 DOI: 10.1093/eurpub/ckw122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Screening and Brief Interventions for alcohol are an effective public health measure to tackle alcohol-related harm, however relatively few countries across the European Union (EU) have implemented them widely. This may be due to a lack of understanding of the specific financial implications of such policies within each country. Methods A novel 'meta-modelling' approach was developed based on previous SBI cost-effectiveness models for four EU countries. Data were collected on the key factors which drive cost-effectiveness for all 28 EU countries (mean per capita alcohol consumption, proportion of the population to be screened over a 10-year SBI programme; per capita alcohol-attributable mortality; per capita alcohol-attributable morbidity; mean cost of an alcohol-related hospitalisation and mean SBI-delivery staff cost). Regression analysis was used to fit two meta-models estimating net programme costs and Quality-Adjusted Life Years (QALYs) gained, to calculate cost-effectiveness estimates specific to each EU country. Results Costs are dependent upon the proportion of the population covered by the screening programme, the country-specific per capita mortality and morbidity rate and the country-specific costs of GP care and hospitalisation. QALYs depend on the proportion of the population screened and per capita alcohol consumption. Despite large inter-country variability in factor values, SBI programmes are likely to be cost-effective in 24 out of 28 EU countries and cost-saving in 50% of countries. Conclusion Implementing national programmes of SBI in primary health care would be a cost-effective means of reducing alcohol-attributable morbidity and deaths in almost all countries of the EU.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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19
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Hill SR, Vale L, Hunter D, Henderson E, Oluboyede Y. Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges. Health Policy 2017; 121:1249-1262. [PMID: 29100609 PMCID: PMC5710990 DOI: 10.1016/j.healthpol.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/15/2017] [Accepted: 10/18/2017] [Indexed: 01/31/2023]
Abstract
There are few economic evaluations of alcohol prevention interventions. Consideration of impacts beyond an individual’s health in evaluations is limited. No published studies using other priority-setting methods in the alcohol area. Consideration of wider societal perspectives and health inequalities is minimal. Including inter-sectoral costs and consequences in evaluations is challenging.
Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions. Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006–2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers. 619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.
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Affiliation(s)
- Sarah R Hill
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - David Hunter
- Centre for Public Policy and Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Emily Henderson
- Centre for Public Policy and Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Yemi Oluboyede
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
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Anderson P, Bendtsen P, Spak F, Reynolds J, Drummond C, Segura L, Keurhorst MN, Palacio-Vieira J, Wojnar M, Parkinson K, Colom J, Kłoda K, Deluca P, Baena B, Newbury-Birch D, Wallace P, Heinen M, Wolstenholme A, van Steenkiste B, Mierzecki A, Okulicz-Kozaryn K, Ronda G, Kaner E, Laurant MGH, Coulton S, Gual T. Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial. Addiction 2016; 111:1935-1945. [PMID: 27237081 DOI: 10.1111/add.13476] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/27/2015] [Accepted: 05/25/2016] [Indexed: 12/19/2022]
Abstract
AIM To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. DESIGN Cluster randomized factorial trial with 12-week implementation and measurement period. SETTING Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. PARTICIPANTS A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. INTERVENTIONS PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. MEASUREMENTS The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. FINDINGS During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53). CONCLUSIONS Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.
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Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle, UK. .,Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden
| | - Fredrik Spak
- Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jillian Reynolds
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Myrna N Keurhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Jorge Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Begoña Baena
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | | | - Paul Wallace
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Maud Heinen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Amy Wolstenholme
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Ben van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | | | - Gaby Ronda
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Miranda G H Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Toni Gual
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
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Barbosa C, Cowell A. Commentary on Zur & Zaric and Shepard et al. (2016): Cost-effectiveness of SBI for alcohol--where are we and where do we want to go? Addiction 2016; 111:840-2. [PMID: 27060581 DOI: 10.1111/add.13362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/27/2022]
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Zur RM, Zaric GS. A microsimulation cost-utility analysis of alcohol screening and brief intervention to reduce heavy alcohol consumption in Canada. Addiction 2016; 111:817-31. [PMID: 26477518 DOI: 10.1111/add.13201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/31/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Screening and brief intervention (SBI) is a public health intervention that has been shown to be effective in reducing heavy alcohol consumption. The aim of this study is to estimate the cost-effectiveness of implementing universal alcohol SBI in primary care in Canada. DESIGN We developed a microsimulation model of alcohol consumption and its effects on 18 alcohol-related causes of death. SETTING The model simulates a Canadian population. PARTICIPANTS The model simulates individuals and their alcohol consumption on a continuous scale starting from age 17 years to death. INTERVENTIONS The reference case assumes no SBI in Canada. The base case assumes screening was conducted using the Alcohol Use Disorders Identification Test (AUDIT) at a threshold score of 8. Additional analyses included evaluating SBI using the AUDIT at threshold scores between 4 and 8 or the Derived Alcohol Use Disorders Identification Test (AUDIT-C) at threshold scores between 3 and 7. MEASUREMENTS The model estimates the direct health-care costs, life years gained and quality-adjusted life years (QALY) gained, which are then used to estimate the incremental cost-effectiveness ratio (ICER) of SBI versus no SBI. FINDINGS SBI with AUDIT (at a threshold score of 8) had an ICER of $8729/QALY. Our results suggest that using AUDIT thresholds between 8 and 4, inclusive, would be cost-effective for the whole population, as well as for men and women individually. Our results suggest that the AUDIT-C would be cost-effective at thresholds of 7 to 3, inclusive, for men, women and the whole population. CONCLUSIONS In Canada, screening and brief intervention via Alcohol Use Disorders Identification Test (AUDIT) and Derived Alcohol Use Disorders Identification Test (AUDIT-C) to reduce heavy alcohol consumption appears to be cost-effective for men and women at Alcohol Use Disorders Identification Test (AUDIT) thresholds of 8 and lower and at Derived Alcohol Use Disorders Identification Test (AUDIT-C) thresholds of 7 and lower.
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Affiliation(s)
- Richard M Zur
- Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.,Optum, Burlington, Ontario, Canada
| | - Gregory S Zaric
- Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.,Epidemiology and Biostatistics, The University of Western Ontario, Ontario, Canada
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Hoang VP, Shanahan M, Shukla N, Perez P, Farrell M, Ritter A. A systematic review of modelling approaches in economic evaluations of health interventions for drug and alcohol problems. BMC Health Serv Res 2016; 16:127. [PMID: 27074871 PMCID: PMC4831174 DOI: 10.1186/s12913-016-1368-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The overarching goal of health policies is to maximize health and societal benefits. Economic evaluations can play a vital role in assessing whether or not such benefits occur. This paper reviews the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to (i) modelling paradigms themselves; (ii) perspectives of costs and benefits and (iii) time frame. Methods Papers that use modelling approaches for economic evaluations of drug and alcohol interventions were identified by carrying out searches of major databases. Results Thirty eight papers met the inclusion criteria. Overall, the cohort Markov models remain the most popular approach, followed by decision trees, Individual based model and System dynamics model (SD). Most of the papers adopted a long term time frame to reflect the long term costs and benefits of health interventions. However, it was fairly common among the reviewed papers to adopt a narrow perspective that only takes into account costs and benefits borne by the health care sector. Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1368-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Van Phuong Hoang
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - Marian Shanahan
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Nagesh Shukla
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Pascal Perez
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
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Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Della Vedova R, Scafuri F, Scafato E, Struzzo P. Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application. JMIR Res Protoc 2016; 5:e36. [PMID: 26944482 PMCID: PMC4799428 DOI: 10.2196/resprot.5232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/28/2015] [Accepted: 01/03/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app. OBJECTIVE We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module. METHODS The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences. RESULTS Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance. CONCLUSIONS The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact. TRIAL REGISTRATION Clinicaltrials.gov NCT 01638338; https://clinicaltrials.gov/ct2/show/NCT01638338 (Archived by WebCite at http://www.webcitation.org/6f0JLZMtq).
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Brennan A, Meier P, Purshouse R, Rafia R, Meng Y, Hill-Macmanus D, Angus C, Holmes J. The Sheffield Alcohol Policy Model - A Mathematical Description. HEALTH ECONOMICS 2015; 24:1368-1388. [PMID: 25270223 DOI: 10.1002/hec.3105] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/31/2014] [Accepted: 08/10/2014] [Indexed: 06/03/2023]
Abstract
This methodology paper sets out a mathematical description of the Sheffield Alcohol Policy Model version 2.0, a model to evaluate public health strategies for alcohol harm reduction in the UK. Policies that can be appraised include a minimum price per unit of alcohol, restrictions on price discounting, and broader public health measures. The model estimates the impact on consumers, health services, crime, employers, retailers and government tax revenues. The synthesis of public and commercial data sources to inform the model structure is described. A detailed algebraic description of the model is provided. This involves quantifying baseline levels of alcohol purchasing and consumption by age and gender subgroups, estimating the impact of policies on consumption, for example, using evidence on price elasticities of demand for alcohol, quantification of risk functions relating alcohol consumption to harms including 47 health conditions, crimes, absenteeism and unemployment, and finally monetary valuation of the consequences. The results framework, shown for a minimum price per unit of alcohol, has been used to provide policy appraisals for the UK government policy-makers. In discussion and online appendix, we explore issues around valuation and scope, limitations of evidence/data, how the framework can be adapted to other countries and decisions, and ongoing plans for further development. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.
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Affiliation(s)
- Alan Brennan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Petra Meier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Robin Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Rachid Rafia
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Yang Meng
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hill-Macmanus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Angus C, Latimer N, Preston L, Li J, Purshouse R. What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care. Front Psychiatry 2014; 5:114. [PMID: 25225487 PMCID: PMC4150206 DOI: 10.3389/fpsyt.2014.00114] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. METHODS Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. RESULTS The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. CONCLUSION This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nicholas Latimer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jessica Li
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Robin Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Colom J, Scafato E, Segura L, Gandin C, Struzzo P. Brief interventions implementation on alcohol from the European health systems perspective. Front Psychiatry 2014; 5:161. [PMID: 25426083 PMCID: PMC4227516 DOI: 10.3389/fpsyt.2014.00161] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/28/2014] [Indexed: 11/13/2022] Open
Abstract
Alcohol-related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, screening and brief interventions (SBI) have proven to be effective in reducing alcohol consumption and alcohol-related problems in primary health care (PHC) and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the World Health Organization, in the global alcohol strategy, the evidence on long term and population-level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives, and monitoring systems developed were adopted. In Italy, cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals' involvement. The population screened has been in general too low to be able to detect any population-level effect, with a negative impact on the acceptability of the program to all stakeholders. This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of health services and the empowerment of the individuals in a health system approach.
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Affiliation(s)
- Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia , Barcelona , Spain
| | | | - Lidia Segura
- Program on Substance Abuse, Public Health Agency of Catalonia , Barcelona , Spain
| | | | - Pierluigi Struzzo
- Regional Centre for the training in Primary Care (Ceformed) , Monfalcone , Italy ; Department of Life Sciences, University of Trieste , Trieste , Italy
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