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Tilhou A, Baldwin M, Alves J. No Time to Wait: Leveraging Primary Care to Treat Stimulant Use Disorder. Am J Prev Med 2024:S0749-3797(24)00145-4. [PMID: 38762205 DOI: 10.1016/j.amepre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Alyssa Tilhou
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Marielle Baldwin
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Justin Alves
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241236028. [PMID: 38494728 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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Solovei A, Mercken L, Jané-Llopis E, Bustamante I, Evers S, Gual A, Medina P, Mejía-Trujillo J, Natera-Rey G, O’Donnell A, Pérez-Gómez A, Piazza M, de Vries H, Anderson P. Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol. Health Promot Int 2023; 38:daab192. [PMID: 34849866 PMCID: PMC10439512 DOI: 10.1093/heapro/daab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Antoni Gual
- Addictions Unit. Psychiatry Dept. Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos. Instituto Carlos III, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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Hallgren KA, Matson TE, Oliver M, Witkiewitz K, Bobb JF, Lee AK, Caldeiro RM, Kivlahan D, Bradley KA. Practical Assessment of Alcohol Use Disorder in Routine Primary Care: Performance of an Alcohol Symptom Checklist. J Gen Intern Med 2022; 37:1885-1893. [PMID: 34398395 PMCID: PMC9198160 DOI: 10.1007/s11606-021-07038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent but underrecognized and undertreated in primary care settings. Alcohol Symptom Checklists can engage patients and providers in discussions of AUD-related care. However, the performance of Alcohol Symptom Checklists when they are used in routine care and documented in electronic health records (EHRs) remains unevaluated. OBJECTIVE To evaluate the psychometric performance of an Alcohol Symptom Checklist in routine primary care. DESIGN Cross-sectional study using item response theory (IRT) and differential item functioning analyses of measurement consistency across age, sex, race, and ethnicity. PATIENTS Patients seen in primary care in the Kaiser Permanente Washington Healthcare System who reported high-risk drinking on the Alcohol Use Disorder Identification Test Consumption screening measure (AUDIT-C ≥ 7) and subsequently completed an Alcohol Symptom Checklist between October 2015 and February 2020. MAIN MEASURE Alcohol Symptom Checklists with 11 items assessing AUD criteria defined in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5), completed by patients during routine medical care and documented in EHRs. KEY RESULTS Among 11,464 patients who screened positive for high-risk drinking and completed an Alcohol Symptom Checklist (mean age 43.6 years, 30.5% female), 54.1% reported ≥ 2 DSM-5 AUD criteria (threshold for AUD diagnosis). IRT analyses demonstrated that checklist items measured a unidimensional continuum of AUD severity. Differential item functioning was observed for some demographic subgroups but had minimal impact on accurate measurement of AUD severity, with differences between demographic subgroups attributable to differential item functioning never exceeding 0.42 points of the total symptom count (of a possible range of 0-11). CONCLUSIONS Alcohol Symptom Checklists used in routine care discriminated AUD severity consistently with current definitions of AUD and performed equitably across age, sex, race, and ethnicity. Integrating symptom checklists into routine care may help inform clinical decision-making around diagnosing and managing AUD.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
| | - Theresa E Matson
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Daniel Kivlahan
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Katharine A Bradley
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Chan PSF, Fang Y, Wong MCS, Huang J, Wang Z, Yeoh EK. Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review. Implement Sci 2021; 16:99. [PMID: 34801041 PMCID: PMC8605518 DOI: 10.1186/s13012-021-01170-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833). Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01170-8.
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Affiliation(s)
- Paul Shing-Fong Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, China
| | - Martin Chi-Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. .,Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. .,Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Center for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Smith MD, Emerick T, Brancolini S, Alter B. Clearing up the Confusion: What to Do with Ethanol and Ethanol Metabolites in Urine Drug Screens. PAIN MEDICINE 2021; 22:2401-2413. [PMID: 33595647 DOI: 10.1093/pm/pnab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael D Smith
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott Brancolini
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benedict Alter
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Dutra Ponce T, León EG, de Vargas D. Reducing women's alcohol use: a brief intervention pilot study at a primary health care service in Brazil. Women Health 2021; 61:737-744. [PMID: 34488548 DOI: 10.1080/03630242.2021.1965692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study assesses the feasibility of a brief intervention among women with hazardous alcohol use at a primary health care service in Brazil. A two-arm randomized pilot study was carried out from July 2017 to January 2018 with 44 women aged 18 years or older with hazardous alcohol use. The intervention group completed a brief intervention in a single session lasting 20 to 30 minutes. The control group received five minutes of brief advice. Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT), and the frequency and quantity of alcohol consumed in the previous month were assessed at baseline and the first and third months of follow-up in both groups. The AUDIT score was decreased in both groups at baseline (intervention group 12.89, control group 10.64), the 1st month (intervention group 12.78 p = .9; control group 7.9 p = .01) and the 3rd month (intervention group 10.11 p = .13; control group 7.09 p < .01). The intervention group continued using alcohol after the brief intervention, although the quantity of alcohol consumed was reduced compared with that at baseline (p < .01). Finally, the brief intervention delivered in a primary health care service in Brazil showed the potential to reduce women's pattern of alcohol consumption.
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Affiliation(s)
- Talita Dutra Ponce
- Department of Mental Health & Psychiatric Nursing, São Paulo University School of Nursing, São Paulo, Brazil
| | - Erika Gisseth León
- Department of Mental Health & Psychiatric Nursing, São Paulo University School of Nursing, São Paulo, Brazil
| | - Divane de Vargas
- Department of Mental Health & Psychiatric Nursing, São Paulo University School of Nursing, São Paulo, Brazil
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Pussig B, Pas L, Li A, Vermandere M, Aertgeerts B, Matheï C. Primary care implementation study to scale up early identification and brief intervention and reduce alcohol-related negative outcomes at the community level (PINO): study protocol for a quasi-experimental 3-arm study. BMC FAMILY PRACTICE 2021; 22:144. [PMID: 34210261 PMCID: PMC8248288 DOI: 10.1186/s12875-021-01479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice. METHODS/DESIGN A quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs' views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection. The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP's, their practice organisation and their EIBI performance will be explored. DISCUSSION The PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining T&S at GP level with community actions. At the same time, it implements and evaluates practice T&S based on the theoretical domains framework. TRIAL REGISTRATION This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (reference number s63342 and G-2020-2177-R2(MAR)) and is registered on clinicaltrials.gov ( NCT04398576 ) in May 2020.
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Affiliation(s)
- Bram Pussig
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Lodewijk Pas
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Ann Li
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Mieke Vermandere
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Bert Aertgeerts
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
| | - Catharina Matheï
- Academic Centre for General Practice, Kapucijnenvoer 33 blok H - bus 7001, 3001 Leuven, KU Belgium
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Pussig B, Van Nuland M, Pas L, Vandelanotte S, Matheï C, Aertgeerts B, Vermandere M. Community involvement facilitating the discussion of alcohol use in primary care: A nominal group study. Eur J Gen Pract 2021; 27:130-139. [PMID: 34165005 PMCID: PMC8231379 DOI: 10.1080/13814788.2021.1936493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Hazardous alcohol use significantly affects health and wellbeing in society. General practitioners (GPs) are uniquely positioned to address this problem by integrating early identification and brief intervention (EIBI) in daily practice. Unfortunately, EIBI implementation remains low. Community-oriented strategies (COS), defined as public health activities directed to the general population, are suggested to address this implementation gap. COS aim to increase the understanding, engagement and empowerment within the population to facilitate EIBI delivery. However, no consensus on what COS should contain exists. Objectives To obtain insight in the stakeholders’ perspectives and create consensus with them on COS with the highest potential to facilitate EIBI delivery. Methods Four nominal group sessions were conducted with 31 stakeholders representing 12 different stakeholder groups from Leuven (Belgium). Stakeholders generated ideas, reflected on them in group and prioritised them anonymously, creating four separate lists. Merging these lists with their relative scores resulted in a master list, which was checked for accuracy through a member check. Qualitative content analysis on the stakeholder’s notes provided an in-depth exploration of their perspectives. Results Twenty-one strategies were identified, nine of which were COS. Highlighting the GPs’ proactive role was considered most relevant. Other foci included creating awareness on the effects of alcohol use and normalising discussing alcohol use within the community. A holistic approach, exceeding the sole focus on COS, combining community, healthcare and government was accentuated. Conclusion Stakeholders emphasise addressing the proactive role of GPs as most promising COS, though it should be delivered within a holistic multi-component approach.
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Affiliation(s)
- Bram Pussig
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marc Van Nuland
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lodewijk Pas
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Catharina Matheï
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Bert Aertgeerts
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Department for Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Bell L, Garnett C, Qian T, Perski O, Potts HWW, Williamson E. Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial. JMIR Res Protoc 2020; 9:e18690. [PMID: 32763878 PMCID: PMC7442945 DOI: 10.2196/18690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Drink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to "Please complete your mood and drinking diaries." Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user's perceived usefulness of the app. OBJECTIVE The primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. METHODS This is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of "Did the user open the app in the hour from 8 pm to 9 pm?". The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. RESULTS Approval was granted by the University College of London's Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. CONCLUSIONS Understanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18690.
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Affiliation(s)
- Lauren Bell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Garnett
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Tianchen Qian
- Department of Statistics, Harvard University, Cambridge, MA, United States
| | - Olga Perski
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Data Research UK, London, United Kingdom
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Rodrigues AM, Haste A, Penn L, Bell R, Summerbell C, White M, Adamson AJ, Sniehotta FF. Stakeholders' perceptions and experiences of the National Health Service diabetes prevention programme in England: qualitative study with service users, intervention providers and deliverers, commissioners and referrers. BMC Health Serv Res 2020; 20:307. [PMID: 32293424 PMCID: PMC7158071 DOI: 10.1186/s12913-020-05160-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The National Health Service diabetes prevention programme in England, (NHS DPP) aims to identify people at high risk of type 2 diabetes (T2D) and offer them a face-to-face, group-based, behaviour change intervention for at least 9 months. The NHS DPP was rolled out in phases. We aimed to elicit stakeholders' perceptions and experiences of the factors influencing implementation of, and participation in, the programme during the development phase. METHODS Individual, semi-structured telephone interviews were conducted with 50 purposively sampled stakeholders: service users (n = 20); programme commissioners (n = 7); referrers (n = 8); and intervention deliverers (n = 15). Topic guides were structured using a pragmatic, theory-informed approach. Analysis employed the framework method. RESULTS We identified factors that influenced participation: Risk communication at referral - stakeholders identified point of referral as a window of opportunity to offer brief advice, to provide an understanding of T2D risk and information about the programme; Perceived impact of the NHS DPP - service users highlighted the positive perceived impact on their behaviour change, the peer support provided by participating in the programme, the option to involve a relative, and the 'knock on' effect on others. Service users also voiced disappointment when blood test results still identified them at high risk after the programme; and Behavioural maintenance - participants highlighted the challenges linked to behavioural maintenance (e.g. discontinuation of active support). Factors influencing implementations were also identified: Case finding - stakeholders suggested that using community involvement to identify service users could increase reach and ensure that the workload was not solely on GP practices; Adaptability: intervention deliverers acknowledged the need to tailor advice to service users' preferences and needs; Accountability - the need to acknowledge who was responsible for what at different stages of the NHS DPP pathway; and Fidelity - stakeholders described procedures involved in monitoring service users' satisfaction, outcome data collection and quality assurance assessments. CONCLUSIONS The NHS DPP offers an evidence-informed behavioural intervention for T2D prevention. Better risk communication specification could ensure consistency at the referral stage and improve participation in the NHS DPP intervention. Cultural adaptations and outreach strategies could ensure the NHS DPP contributes to reducing health inequalities.
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Affiliation(s)
- Angela M. Rodrigues
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST UK
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Anna Haste
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BX UK
| | - Linda Penn
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Bell
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
| | - Carolyn Summerbell
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Faculty of Social Sciences and Health, Durham University, Durham City, DH1 3HN UK
| | - Martin White
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Ashley J. Adamson
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- NIHR Policy Research Unit Behavioural Science, Baddiley Clark Building, Newcastle upon Tyne, NE2 4AX UK
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Schulte B, O’Donnell A, Lahusen H, Lindemann C, Prilutskaya M, Yussopov O, Kaliyeva Z, Martens MS, Verthein U. Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial. Pilot Feasibility Stud 2020; 6:3. [PMID: 31938551 PMCID: PMC6953225 DOI: 10.1186/s40814-019-0547-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/20/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients' and physicians' perspectives. METHODS Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention). DISCUSSION This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan. TRIAL REGISTRATION DRKS, DRKS00015882, Registered 17 December 2018.
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Affiliation(s)
- Bernd Schulte
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Harald Lahusen
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christina Lindemann
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | | | - Oleg Yussopov
- Monitoring Center on Alcohol and Drugs, Pavlodar, Kazakhstan
| | - Zhanar Kaliyeva
- Sanjar Dzhafarovich Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Marcus-Sebastian Martens
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Uwe Verthein
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Schulte B, Lindemann C, Buchholz A, Rosahl A, Härter M, Kraus L, Kiefer F, Frischknecht U, Hoffmann S, Wensing M, O`Donnell A, Manthey J, Rehm J, Schäfer I, Verthein U, Reimer J. Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2019. [DOI: 10.1024/0939-5911/a000629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Lindemann
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE, Eötvös-Loránd-Universität, Budapest, Hungary
| | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Feuerlein Centrum für Translationale Suchtmedizin, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Amy O`Donnell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Health North, Bremen, Germany
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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White GE, Richardson GA, Mair C, Courcoulas AP, King WC. Do Associations Between Alcohol Use and Alcohol Use Disorder Vary by Weight Status? Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III. Alcohol Clin Exp Res 2019; 43:1498-1509. [PMID: 31034607 DOI: 10.1111/acer.14071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding whether the associations between alcohol use and alcohol use disorder (AUD) differ by weight status may be useful in screening for AUD in populations where obesity is common. We aimed to determine whether the associations between alcohol use and AUD differ by weight status. METHODS A total of 24,869 adult participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III with a body mass index ≥18.5 kg/m2 who reported past-year alcohol use were included. The AUD and Associated Disabilities Interview Schedule-5 were administered to identify past-year AUD. Logistic regression was used to test the associations between weight status and levels and patterns of alcohol use with AUD; interactions between weight status and alcohol use variables in relation to AUD were examined. Analyses were stratified by gender. RESULTS For males and females, the odds of AUD were higher with greater frequency of any alcohol use and heavy drinking, higher average quantity of drinks per drinking day, and past-year high-risk drinking. Among males, at the same average quantity of drinks per drinking day, frequency of heavy drinking, or presence of high-risk drinking, those with class 3 obesity had higher odds of AUD versus lower classes or no obesity (p for all interactions <0.01). Among females, at the same frequency of any alcohol use, those with healthy weight had the highest odds of AUD, while females with class 3 obesity had the lowest odds of AUD (p for interaction <0.001); interactions between weight status and other alcohol use variables were not significant (p ≥ 0.05). CONCLUSIONS The associations between some measures of alcohol use and AUD differed by weight status, with inconsistent results between males and females. Alcohol use thresholds typically used in AUD screening may be too high in males with class 3 obesity.
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Affiliation(s)
- Gretchen E White
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Abstract
PURPOSE OF REVIEW Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. RECENT FINDINGS Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
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Rumpf HJ, Bischof A, Bischof G, Besser B, Brand D, Rehbein F. Early Intervention in Gaming Disorder: What Can We Learn from Findings in the Substance Abuse Field? CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0229-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry 2018; 31:324-332. [PMID: 29846264 DOI: 10.1097/yco.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field. RECENT FINDINGS Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included. SUMMARY Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.
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