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Freyer-Adam J, Baumann S, Bischof G, Staudt A, Goeze C, Gaertner B, John U. Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial. JMIR Ment Health 2022; 9:e31712. [PMID: 35089156 PMCID: PMC8838551 DOI: 10.2196/31712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated. OBJECTIVE We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants' socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed). METHODS Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling. RESULTS The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24-0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31). CONCLUSIONS Computer-based and in-person BAI worked equally well independent of the patient's level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status. TRIAL REGISTRATION ClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Sophie Baumann
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Lübeck, Luebeck, Germany
| | - Andreas Staudt
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Goeze
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research (DZHK), Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Baumann S, Staudt A, Freyer-Adam J, Bischof G, Meyer C, John U. Effects of a brief alcohol intervention addressing the full spectrum of drinking in an adult general population sample: a randomized controlled trial. Addiction 2021; 116:2056-2066. [PMID: 33449418 DOI: 10.1111/add.15412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/30/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Evidence for efficacy of brief alcohol interventions (BAIs) is mainly limited to primary care and at-risk drinkers. The aim was to test the efficacy of a BAI addressing the full spectrum of alcohol use in a general population sample and across alcohol risk groups. DESIGN Two-parallel-group randomized controlled trial (allocation ratio 1:1) with post-baseline assessments at months 3, 6 and 12. SETTING One municipal registry office in Germany responsible for registration, passport and vehicle admission issues. PARTICIPANTS A total of 1646 proactively recruited 18-64-year-old adults with past year alcohol use (56% women, 66% low-risk drinkers) were randomized to intervention (n = 815) or control (n = 831). INTERVENTION AND COMPARATOR The intervention consisted of assessment plus computer-generated individualized feedback letters at baseline and months 3 and 6. Comparator was assessment only. MEASUREMENTS Primary outcome was change in the self-reported number of drinks/week from baseline to 12 months. Changes at 3 and 6 months were secondary outcomes. Moderator was alcohol risk group (low-risk versus at-risk drinking) according to the Alcohol Use Disorders Identification Test-Consumption, with scores from 1-3 (women) and from 1-4 (men) indicating low-risk drinking. FINDINGS For the whole sample, significant group differences were observed neither at 12-month follow-up [incidence rate ratio (IRR) = 1.01, 95% confidence interval (CI) = 0.87-1.17, Bayes factor (BE) = 0.52] nor at previous assessments (month 3: IRR = 1.01, 95% CI = 0.92-1.12, BE = 0.41; month 6: IRR = 0.93, 95% CI = 0.81-1.07, BE = 1.10). Moderator analyses revealed that low-risk drinkers were more likely to benefit from BAI only at month 6 than at-risk drinkers (IRR = 0.77, 95% CI = 0.70-0.86). CONCLUSIONS In a randomized controlled trial, there was no clear evidence for efficacy of a computer-based brief alcohol intervention in a general population sample, but there was some evidence of medium-term benefits in the large but understudied group of low-risk drinkers.
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Affiliation(s)
- Sophie Baumann
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Staudt
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany.,Institute of Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Christian Meyer
- Institute of Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Greifswald, Germany
| | - Ulrich John
- Institute of Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Greifswald, Germany
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Barticevic NA, Poblete F, Zuzulich SM, Rodriguez V, Quevedo D, Sena BF, Bradshaw L. A Health Technician-delivered Brief Intervention linked to AUDIT for reduction of alcohol use in Chilean primary care: a randomized controlled trial. Addict Sci Clin Pract 2021; 16:39. [PMID: 34130748 PMCID: PMC8207593 DOI: 10.1186/s13722-021-00248-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/08/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .
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Affiliation(s)
- Nicolas A Barticevic
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Alameda 340, 8331150, Santiago, Chile
| | - Fernando Poblete
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Alameda 340, 8331150, Santiago, Chile.
| | - Soledad M Zuzulich
- Pontificia Universidad Católica de Chile, Nursing School. Alameda 340, 8331150, Santiago, Chile
| | - Victoria Rodriguez
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Alameda 340, 8331150, Santiago, Chile
| | - Diego Quevedo
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Alameda 340, 8331150, Santiago, Chile
| | - Brena F Sena
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Laura Bradshaw
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Alameda 340, 8331150, Santiago, Chile
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Freyer-Adam J, Baumann S, Bischof G, John U, Gaertner B. Sick days in general hospital patients two years after brief alcohol intervention: Secondary outcomes from a randomized controlled trial. Prev Med 2020; 139:106106. [PMID: 32353573 DOI: 10.1016/j.ypmed.2020.106106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/11/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023]
Abstract
Little is known about the long-term impact of brief alcohol interventions (BAIs) on health and on sick days in particular. The aim was to investigate whether BAIs reduce sick days in general hospital patients over two years, and whether effects depend on how BAIs are delivered; either through in-person counseling (PE) or computer-generated written feedback (CO). To investigate this, secondary outcome data from a three-arm randomized controlled trial with 6-, 12-, 18- and 24-month follow-ups were used. The sample included 960 patients (18-64 years) with at-risk alcohol use identified through systematic screening on 13 hospital wards. Patients with particularly severe alcohol problems were excluded. Participants were allocated to PE, CO and assessment only (AO). Both interventions were tailored according to behavior change theory and included three contacts. Self-reported number of sick days in the past 6 months was assessed at all time-points. A zero-inflated negative binomial latent growth model adjusted for socio-demographics, substance use related variables and medical department was calculated. In comparison to AO, PE (OR = 2.18, p = 0.047) and CO (OR = 2.08, p = 0.047) resulted in statistically significant increased odds of reporting no sick days 24 months later. Differences between PE and CO, and concerning sick days when any reported, were non-significant. This study provides evidence for the long-term efficacy of BAIs concerning health, and concerning sick days in particular. BAIs have the potential to reduce the occurrence of sick days over 2 years, independent of whether they are delivered through in-person counseling or computer-generated written feedback.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research, Site Greifswald, Greifswald, Germany.
| | - Sophie Baumann
- German Center for Cardiovascular Research, Site Greifswald, Greifswald, Germany; Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Luebeck, Luebeck, Germany
| | - Ulrich John
- German Center for Cardiovascular Research, Site Greifswald, Greifswald, Germany; Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
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Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation. Transplantation 2020; 104:293-298. [PMID: 31283683 DOI: 10.1097/tp.0000000000002843] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The morbidity and mortality from alcohol-related liver disease (ALD) is increasing in the United States. However, little is known about gender differences in evaluation and listing for liver transplantation (LT) in patients with ALD. METHODS This is a retrospective review of adult patients with ALD evaluated for LT at a single transplant center from January 1, 2010, to March 1, 2017. Univariate, multivariate, and time-series analyses were performed. RESULTS Among the 949 patients with ALD evaluated, mean age was 53 years, 84% were Caucasian, and 33% were women. The median model for end-stage liver disease score was similar between the genders. Women were less likely to be listed for LT (10% versus 19%; P < 0.05). The proportion of women not listed due to active substance use was significantly higher versus men (42% versus 35%; P < 0.05), while the frequency of medical contraindications was comparable between the genders. During a median follow-up of 416 days (range: 0-2784), listed women with ALD were less likely to undergo transplantation (42% versus 47%; P < 0.05). CONCLUSIONS Men with ALD were 95% more likely to be listed and 105% more likely to be transplanted compared to women with ALD. While men had more lifetime substance use and related consequences, women had more psychiatric comorbidities and were less likely to be listed due to active alcohol and opioid use. Early detection and effective treatment of psychiatric and substance use disorders in women with ALD may improve their transplant eligibility.
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Madden M, Morris S, Ogden M, Lewis D, Stewart D, McCambridge J. Producing co-production: Reflections on the development of a complex intervention. Health Expect 2020; 23:659-669. [PMID: 32233053 PMCID: PMC7321726 DOI: 10.1111/hex.13046] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patient and public involvement and co-production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they are, how they might be undertaken and how they relate to each other. There are distinct challenges and particular gaps in public involvement in alcohol research, especially when the study focus is on health matters other than alcohol dependence. OBJECTIVE To explore how patient and public involvement and co-production have been interpreted and applied within a multi-disciplinary research programme in the development of a complex intervention on alcohol and medicine use in community pharmacies. DESIGN The paper presents the authors' critical reflection on a grounded example of how public involvement concepts have been translated into practice in the intervention development phase of a publicly funded research programme, noting its impact on the programme to date. DISCUSSION Co-production adds another layer of complexity in the development of a complex intervention. The research planning requirements for publicly funded research circumscribe the possibilities for co-production, including impacting on the possibility of stability and continuity over time.
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Kim J, Hendershot CS. A review of performance indicators of single-item alcohol screening questions in clinical and population settings. J Subst Abuse Treat 2020; 111:73-85. [DOI: 10.1016/j.jsat.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
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Freyer-Adam J, Baumann S, Haberecht K, Bischof G, Meyer C, Rumpf HJ, John U, Gaertner B. Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial. Psychol Med 2019; 49:1722-1730. [PMID: 30178727 DOI: 10.1017/s0033291718002453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO). METHODS Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0-100) and a one-item general health measure (0, poor - 4, excellent). RESULTS Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p < 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly. CONCLUSIONS Beyond drinking reduction, PE and CO can improve general hospital inpatients' self-reported mental and general health over 2 years.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald,Greifswald,Germany
| | - Sophie Baumann
- German Center for Cardiovascular Research,Site Greifswald,Germany
| | - Katja Haberecht
- German Center for Cardiovascular Research,Site Greifswald,Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy,Medical University of Luebeck,Luebeck,Germany
| | - Christian Meyer
- German Center for Cardiovascular Research,Site Greifswald,Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy,Medical University of Luebeck,Luebeck,Germany
| | - Ulrich John
- German Center for Cardiovascular Research,Site Greifswald,Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring,Robert Koch Institute Berlin,Berlin,Germany
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Beyer F, Lynch E, Kaner E. Brief Interventions in Primary Care: an Evidence Overview of Practitioner and Digital Intervention Programmes. CURRENT ADDICTION REPORTS 2018; 5:265-273. [PMID: 29963364 PMCID: PMC5984646 DOI: 10.1007/s40429-018-0198-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW Excessive drinking is a major public health problem that adversely affects all parts of the population. Previous systematic reviews and meta-analyses have reported that brief interventions delivered in primary care are effective at reducing alcohol consumption, albeit with small effect sizes that have decreased over time. This review summarises the updated evidence base on practitioner and digitally delivered brief interventions. RECENT FINDINGS Using Cochrane methodology, 69 primary care brief intervention trials (33,642 participants) and 57 digital intervention trials (34,390 participants) were identified. Meta-analyses showed both approaches significantly reduced consumption compared to controls. Five trials (390 participants) compared practitioner-delivered and digital interventions directly with no evidence of difference in outcomes at follow-up. SUMMARY Brief interventions have the potential to impact at both individual and population levels. Future research should focus on optimising components and delivery mechanisms, and on alcohol-related harms. Digital interventions may overcome some of the implementation barriers faced by practitioner-delivered interventions.
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Affiliation(s)
- Fiona Beyer
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Kramer Schmidt L, Bojesen AB, Nielsen AS, Andersen K. Duration of therapy - Does it matter?: A systematic review and meta-regression of the duration of psychosocial treatments for alcohol use disorder. J Subst Abuse Treat 2017; 84:57-67. [PMID: 29195594 DOI: 10.1016/j.jsat.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The recommendations in clinical guidelines for duration of therapy for alcohol use disorder (AUD) are based on consensus decisions. In reality, we do not know the optimal duration of an alcohol treatment course. METHODS A systematic review and meta-regression of randomized controlled trials of psychosocial treatment in alcohol outpatient treatment centers. The population consisted of adults suffering from AUD, treated in an outpatient facility with at least two sessions of therapy. Meta-regression analysis was performed with treatment outcome as a function of duration of therapy across studies. Treatment outcome was defined as long-term alcohol use measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), and/or proportion of participants abstinent (ABS). RESULTS 48 studies encompassing 8984 participants. Mean planned duration of therapy: 18 (8-82) weeks and 14 (2-36) sessions. Mean actual attended sessions: 9 (1-26). Mean follow-up time: 43 (8-104) weeks with a mean of 6 (2-18) research assessments. Neither planned weeks, duration of sessions, frequency of sessions per week, nor actual attended sessions were associated with long-term alcohol use outcomes. However, frequency of research assessments was positively associated with PDA and PHD. CONCLUSION No associations between long-term alcohol use outcomes and planned or actual attended duration of psychosocial treatment in outpatient care. Research assessments and, accordingly, the research project in itself may influence outcome in studies of psychosocial treatment for alcohol use disorder.
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Affiliation(s)
- Lotte Kramer Schmidt
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 20, entrance 220B, 5000 Odense C, Denmark.
| | - Anders Bo Bojesen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; OPEN Odense Patient data Explorative Network, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; Department of Mental Health, Region of Southern Denmark, Denmark
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12
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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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13
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Anderson P, O'Donnell A, Kaner E, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Rehm J. Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study. F1000Res 2017; 6:311. [PMID: 29188013 PMCID: PMC5686480 DOI: 10.12688/f1000research.11173.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/27/2022] Open
Abstract
Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1
st December 2017.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6221 HA, Netherlands
| | - Amy O'Donnell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic of Barcelona, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, 08036, Spain.,Red de Trastornos Adictivo, Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, 6200, Netherlands
| | | | - Jürgen Rehm
- Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, 01187, Germany
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14
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Anderson P, Kaner E, Keurhorst M, Bendtsen P, Steenkiste BV, Reynolds J, Segura L, Wojnar M, Kłoda K, Parkinson K, Drummond C, Okulicz-Kozaryn K, Mierzecki A, Laurant M, Newbury-Birch D, Gual A. Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E121. [PMID: 28134783 PMCID: PMC5334675 DOI: 10.3390/ijerph14020121] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/18/2022]
Abstract
In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.
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Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
- Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands.
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
| | - Myrna Keurhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands.
- Centre for Nursing Research, Saxion University of Applied Sciences, Deventer 7513, The Netherlands.
| | - Preben Bendtsen
- Department of Medical Specialist, Linköping University, Motala 58183, Sweden.
- Department of Medicine and Health, Linköping University, Motala 58183, Sweden.
| | - Ben van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands.
| | - Jillian Reynolds
- Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain.
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona 08003, Spain.
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw 02-091, Poland.
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland.
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London WC2B 5RL, UK.
- National Institute for Health Research Biomedical Research Centre for Mental Health, Maudsley NHS Foundation Trust, London SE5 8AF, UK.
| | | | - Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland.
| | - Miranda Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands.
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen 6525, The Netherlands.
| | | | - Antoni Gual
- Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain.
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15
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A theory-based implementation program for alcohol screening and brief intervention (ASBI) in general practices: Planned development and study protocol of a cluster randomised controlled trial. Contemp Clin Trials 2016; 51:78-87. [DOI: 10.1016/j.cct.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 11/21/2022]
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16
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Heather N. Spreading alcohol brief interventions from health care to non-health care settings: Is it justified? DRUGS: EDUCATION, PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1187113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Lid TG, Eide GE, Dalen I, Meland E. Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder? Scand J Prim Health Care 2016; 34:215-23. [PMID: 27404326 PMCID: PMC5036010 DOI: 10.1080/02813432.2016.1207138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders. DESIGN We extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder. SETTING Nine general practitioner surgeries with varying size and stability. SUBJECTS Totally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age. METHODS The Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years. MAIN OUTCOME MEASURES Time from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem. RESULTS In the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios. CONCLUSIONS Many frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool. KEY POINTS Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in primary health care have not been successful. Many frequent clinical problems recorded in electronic patient records may indicate an increased risk for alcohol related health problems. The hazard ratios were modest and the resulting predictive model was unsatisfactory for diagnostic purposes. If we accepted a sensitivity as low as 0.50, the specificity slightly exceeded 0.75. With a low prevalent condition, it is obvious that the false positive problem will be vast. In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.
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Affiliation(s)
- Torgeir Gilje Lid
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, Uni Health, Uni Research, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- CONTACT Torgeir Gilje Lid Rasmus Risas Gate 54, N-4015 Stavanger, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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18
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Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics. J Addict Med 2016; 9:417-26. [PMID: 26428361 DOI: 10.1097/adm.0000000000000151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to compare demographic, clinical, and survival characteristics of drug-using safety-net primary care patients who used or did not use opioids, and to examine treatment implications of our findings. METHODS The sample consisted of 868 adults who reported illicit drug use in the 90 days before study enrollment, 396 (45.6%) of whom were opioid users. RESULTS Multiple measures indicated that, as a group, opioid users were less physically and psychiatrically healthy than drug users who did not endorse using opioids, and were heavy users of medical services (eg, emergency departments, inpatient hospitals, and outpatient medical) at considerable public expense. After adjusting for age, they were 2.61 (confidence interval, 1.48-4.61) times more likely to die in the 1 to 5 years after study enrollment and more likely to die from accidental poisoning than nonopioid users. Subgroup analyses suggested patients using any nonprescribed opioids had more serious drug problems including more intravenous drug use and greater HIV risk than patients using opioids only as prescribed. CONCLUSIONS Use of opioids adds a dimension of severity over and above illicit drug use as it presents in the primary care setting. Opioid users may benefit from psychiatric and addiction care integrated into their primary care setting, naloxone overdose prevention kits, and prevention efforts such as clean needle exchanges. Addiction or primary care providers are in a key position to facilitate change among such patients, especially the third or more opioid users having a goal of abstinence from drugs.
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19
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Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care. J Addict Nurs 2016; 27:78-85. [DOI: 10.1097/jan.0000000000000118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Hadland SE, Knight JR. Brief Interventions for Alcohol Use: Where, When, and How? Pediatrics 2015; 136:e1002-4. [PMID: 26347439 PMCID: PMC4586734 DOI: 10.1542/peds.2015-2713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Scott E. Hadland
- Division of Adolescent/Young Adult Medicine, and,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John R. Knight
- Center for Adolescent Substance Abuse Research, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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21
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Kalu N, Cain G, McLaurin-Jones T, Scott D, Kwagyan J, Fassassi C, Greene W, Taylor RE. Impact of a multicomponent screening, brief intervention, and referral to treatment (SBIRT) training curriculum on a medical residency program. Subst Abus 2015; 37:242-7. [PMID: 25961140 DOI: 10.1080/08897077.2015.1035841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance-related disorders are a growing problem in the United States. The patient-provider setting can serve as a crucial environment to detect and prevent at-risk substance use. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated approach to deliver early intervention and treatment services for persons who have or are at risk for substance-related disorders. SBIRT training components can include online modules, in-person instruction, practical experience, and clinical skills assessment. This paper will evaluate the impact of multiple modes of training on acquisition of SBIRT skills as observed in a clinical skills assessment. METHODS Residents were part of an SBIRT training program, from 2009 through 2013, consisting of lecture, role-play, online modules, patient encounters, and clinical skills assessment (CSA). Differences were assessed across satisfactory and unsatisfactory CSA performance. RESULTS Seventy percent of the residents satisfactorily completed CSA. Demographics, type of components completed, and number of components completed were similar among residents who demonstrated satisfactory clinical skills compared with those who did not. All components of the training program were accepted equally across specialties and resident matriculation cohorts. CONCLUSION The authors conclude that the components employed in SBIRT training do not have to be numerous or of a particular mode of training in order to see observable demonstration of SBIRT skills among medical residents. Thus, residency educators who have limited time or resources may utilize as few as 1 mode of training to effectually disseminate SBIRT skills among health care providers. As SBIRT continues to evolve as a promising tool to address at-risk substance-related disorders, it is critical to train medical residents and other health professionals.
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Affiliation(s)
- Nnenna Kalu
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - Gloria Cain
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - TyWanda McLaurin-Jones
- b Department of Community and Family Medicine , Howard University , Washington , DC , USA
| | - Denise Scott
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
| | - John Kwagyan
- c Georgetown-Howard Universities Center for Clinical and Translation Science (GHUCCTS) , Howard University College of Medicine/Howard University Hospital , Washington , DC , USA
| | - Catsim Fassassi
- d Howard-Hopkins Surgical Outcomes Research Center , Washington , DC , USA.,e Howard University Hospital Trauma and Critical Care , Washington , DC , USA
| | - Wendy Greene
- e Howard University Hospital Trauma and Critical Care , Washington , DC , USA
| | - Robert E Taylor
- a SBIRT Medical Residency Program , Howard University , Washington , DC , USA
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