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Lavelle-Cafferkey S, Comiskey C. Role of the addiction clinical nurse specialist in acute hospital settings. Nurs Stand 2024:e12305. [PMID: 38680049 DOI: 10.7748/ns.2024.e12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The role of an addiction clinical nurse specialist (ACNS) is focused on individuals who misuse drugs and alcohol, and several benefits of the role have been identified in the literature. When people who misuse substances are admitted to acute general hospitals, there is an opportunity to engage with them and ensure they access support services to facilitate their recovery. AIM To determine general nurses' experience of caring for patients who misuse substances, and to gauge nurses' views on the implementation of an ACNS role in an acute general hospital. METHOD This study used a qualitative design involving online interviews with 11 hospital nurses. FINDINGS Many participants felt that an ACNS could provide them with education and support around substance misuse, while also advocating for patients who misuse substances, reducing stigma and enhancing patient care. CONCLUSION Participants indicated several benefits to implementing an ACNS role in their hospital, such as ensuring that patients who misuse substances experienced continuity of care which began at admission, was followed-up during inpatient stays and was maintained in the community.
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Affiliation(s)
- Sadie Lavelle-Cafferkey
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland
| | - Catherine Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland
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2
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Palacios-Delgado J, Garduño FAG. A mobile phone intervention to reduce heavy drinking: a preliminary analysis of anchoring heuristics. BMC Psychol 2023; 11:427. [PMID: 38057842 DOI: 10.1186/s40359-023-01465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Preliminary evidence has been presented for interventions focused on preventing alcohol consumption or reducing the occurrence of episodes of excessive drinking. The anchoring text message intervention is a newly proposed theory-based approach to reducing heavy drinking among youth. The current study tests the preliminary efficacy of this intervention for reducing heavy drinking among Mexican youth. METHODS Focusing on a sample of sixteen Mexican youths-nine not-heavy drinkers and seven heavy drinkers-the participants completed a survey on alcohol consumption and anchoring heuristics. Pretest and post-test questionnaire data were collected to evaluate the effectiveness of the intervention. The anchoring text messages consisted of strategies to limit alcohol use and feedback reminder messages. Assessments were conducted at baseline, four weeks of intervention, and post-intervention. RESULTS Logistic regression analyses indicated a significant effect on heavy drinking episodes post-intervention. The post-intervention anchoring effects among the heavy drinker participants were different from those among the non-heavy drinkers in terms of reporting heavy drinking and future drinking. The anchoring heuristic-based intervention reduced the quantity of drinking and the future estimation of drinking and improved the ability to reject alcohol in the heavy drinker group. CONCLUSIONS These findings provide preliminary support for the effectiveness of the anchoring heuristic-based intervention, conducted through text messages sent by mobile phone to reduce alcohol consumption. The intervention promoted a reduction in alcohol consumption. Future research should be directed toward investigating the anchoring effects among heavy drinkers.
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Affiliation(s)
- Jorge Palacios-Delgado
- Universidad del Valle de México, Querétaro, México.
- Unidad de Investigación en Neurociencias Aplicadas, Querétaro, México.
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Guertler D, Krause K, Moehring A, Bischof G, Batra A, Freyer-Adam J, Ulbricht S, Rumpf HJ, Wurm S, Cuijpers P, Lucht M, John U, Meyer C. E-Health intervention for subthreshold depression: Reach and two-year effects of a randomized controlled trial. J Affect Disord 2023; 339:33-42. [PMID: 37392942 DOI: 10.1016/j.jad.2023.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND There is evidence for e-Health interventions for full-blown depression. Little is known regarding commonly untreated subthreshold depression in primary care. This randomized controlled multi-centre trial assessed reach and two-year-effects of a proactive e-Health intervention (ActiLife) for patients with subthreshold depression. METHODS Primary care and hospital patients were screened for subthreshold depression. Over 6 months, ActiLife participants received three individualized feedback letters and weekly messages promoting self-help strategies against depression, e.g., dealing with unhelpful thoughts or behavioural activation. The primary outcome depressive symptom severity (Patient Health Questionnaire;PHQ-8) and secondary outcomes were assessed 6, 12 and 24 months. RESULTS Of those invited, n = 618(49.2 %) agreed to participate. Of them, 456 completed the baseline interview and were randomized to ActiLife (n = 227) or assessment only (n = 226). Generalised estimation equation analyses adjusting for site, setting and baseline depression revealed that depressive symptom severity declined over time, with no significant group differences at 6 (mean difference = 0.47 points; d = 0.12) and 24 months (mean difference = -0.05 points; d = -0.01). Potential adverse effects were observed at 12 months, with higher depressive symptom severity for ActiLife than control participants (mean difference = 1.33 points; d = 0.35). No significant differences in rates of reliable deterioration or reliable improvement of depressive symptoms were observed. ActiLife increased applied self-help strategies at 6 (mean difference = 0.32; d = 0.27) and 24 months (mean difference = 0.22; d = 0.19), but not at 12 months (mean difference = 0.18; d = 0.15). LIMITATIONS Self-report measures and lack of information on patients' mental health treatment. DISCUSSION ActiLife yielded satisfactory reach and increased the use of self-help strategies. Data were inconclusive in terms of depressive symptom changes.
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Affiliation(s)
- D Guertler
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany.
| | - K Krause
- Evangelic Hospital Bethania, Greifswald, Germany
| | - A Moehring
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany; Institute for Community Medicine, Department of Methods in Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - G Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - A Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - J Freyer-Adam
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - S Ulbricht
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - H J Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - S Wurm
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M Lucht
- Department of Psychiatry and Psychotherapy at Helios Hanseklinikum Stralsund, Stralsund, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - U John
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - C Meyer
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
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Oldroyd C, Greenham O, Martin G, Allison M, Notley C. Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol-associated hepatitis. Aliment Pharmacol Ther 2023; 58:763-773. [PMID: 37602505 DOI: 10.1111/apt.17665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Alcohol use is the most important factor in determining the prognosis of patients with alcohol-related cirrhosis and alcohol-associated hepatitis. AIM To conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol-associated hepatitis. METHODS We searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non-randomised studies. Risk of bias was assessed using validated tools. Where possible, meta-analysis was performed. RESULTS Twenty-three studies met the inclusion criteria including six randomised trials and 17 non-randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4-16.1). Three non-randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta-analysis of non-randomised studies that examined the impact of psychological therapies revealed statistically non-significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38-9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12-1.77). CONCLUSIONS Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non-randomised studies also point to non-pharmaceutical interventions possibly improving clinical outcomes.
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Affiliation(s)
- Christopher Oldroyd
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivia Greenham
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham Martin
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Michael Allison
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caitlin Notley
- Addiction Research Group, University of East Anglia, Norwich, UK
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Liang W, Chih H, Chikritzhs T. Predicting Alcohol Consumption Patterns for Individuals with a User-Friendly Parsimonious Statistical Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2581. [PMID: 36767944 PMCID: PMC9914951 DOI: 10.3390/ijerph20032581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Many studies on the relationship between alcohol and health outcome focus primarily on average consumption over time and do not consider how heavy per-occasion drinking may influence apparent relationships. Improved methods concerning the most recent drinking occasion are essential to inform the extent of alcohol-related health problems. We aimed to develop a user-friendly and readily replicable computational model that predicts: (i) an individual's probability of consuming alcohol ≥2, 3, 4… drinks; and (ii) the total number of days during which consumption is ≥2, 3, 4… drinks over a specified period. Data from the 2010 and 2011 National Survey on Drug Use and Health (NSDUH) were used to develop and validate the model. Predictors used in model development were age, gender, usual number of drinks consumed per day, and number of drinking days in the past 30 days. Main outcomes were number of drinks consumed on the last drinking occasion in the past 30 days, and number of days of risky levels of consumption. The area under ROC curves ranged between 0.86 and 0.91 when predicting the number of drinks consumed. Coefficients were very close to 1 for all outcomes, indicating closeness between the predicted and observed values. This straightforward modelling approach can be easily adopted by public health behavioral studies.
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Affiliation(s)
- Wenbin Liang
- School of Public Health, Fujian Medical University, Fuzhou 350108, China
- Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, NT 0810, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO U1987, Perth, WA 6845, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO U1987, Perth, WA 6845, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO U1987, Perth, WA 6845, Australia
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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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Chander G, Hutton HE, Xu X, Canan CE, Gaver J, Finkelstein J, Lesko CR, McCaul ME, Lau B. Computer delivered intervention for alcohol and sexual risk reduction among women attending an urban sexually transmitted infection clinic: A randomized controlled trial. Addict Behav Rep 2021; 14:100367. [PMID: 34938828 PMCID: PMC8664779 DOI: 10.1016/j.abrep.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Unhealthy alcohol use is prevalent among women attending STI clinics. We tested whether CBI or CBI-IVR-TM, reduced alcohol use among women in this setting. Neither CBI nor CBI-IVR-TM reduced alcohol use more than control. 2/3 of women had an alcohol use disorder, 65% substance use, 28% depressive symptoms. CBI is insufficient for alcohol reduction in this high severity, high comorbidity setting.
Objective We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control. Methods We conducted a 3-arm RCT among women (n = 439) recruited from Baltimore City Sexually Transmitted Infection (STI) Clinics. Eligibility included: 1) consumption of >7 drinks per week or 2) ≥2 episodes of heavy episodic drinking or ≥2 episodes of sex under the influence of alcohol in the prior three months. Research assessments conducted at baseline, 3, 6 and 12 months included a 30-day Timeline Followback querying daily alcohol use, drug use, and sexual activity. We used the MINI International Neuropsychiatric Interview-DSM-IV to ascertain drinking severity. Primary alcohol outcomes included: drinking days, heavy drinking days, drinks per drinking day. Secondary sexual risk outcomes included number of sexual partners, days of condomless sex, and days of condomless sex under the influence of drugs and alcohol. Results Median age was 31 (IQR 25–44 years), 88% were African American, 65% reported current recreational drug use, and 26% endorsed depressive symptoms. On the MINI 66% met criteria for alcohol use disorder (49% alcohol dependence, 18% abuse). At follow-up, all three groups reduced drinking days, heavy drinking days, drinks per drinking day and drinks per week with no significant differences between study arms. There was no difference in sexual risk outcomes among the groups. Conclusions Among women attending an urban STI clinic single session CBI with or without IVR and text message boosters was insufficient to reduce unhealthy alcohol use or sexual risk behaviors beyond control. The high severity of alcohol use and the prevalence of mental health symptoms and other substance use comorbidity underscores the importance of developing programs that address not only alcohol use but other determinants of STI risk among women.
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Affiliation(s)
- Geetanjali Chander
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Xiaoqiang Xu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Chelsea E Canan
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Jennifer Gaver
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Joseph Finkelstein
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, United States
| | - Catherine R Lesko
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Mary E McCaul
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Bryan Lau
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
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Enders CE, Staudt A, Freyer-Adam J, Meyer C, Ulbricht S, John U, Baumann S. Brief alcohol intervention at a municipal registry office: reach and retention. Eur J Public Health 2021; 31:418-423. [PMID: 33152067 DOI: 10.1093/eurpub/ckaa195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim was to investigate the suitability of a municipal registry office for alcohol screening and brief intervention. We analyzed whether trial participation and retention differ by alcohol- and health-related, demographic and socio-economic participant characteristics. METHODS Over 3 months, all 18- to 64-year-old visitors of a registry office were systematically screened. Persons with alcohol consumption in the past 12 months (N = 1646) were randomized to brief alcohol intervention (BAI) or assessment only. BAI was delivered by computer-generated individualized feedback letters at baseline, 3 and 6 months. Logistic and ordered logistic regression models were used to investigate whether the odds of trial participation and retention depended on participant characteristics. Models were rerun separately for low-risk and at-risk drinkers with Alcohol Use Disorder Identification Test-Consumption scores ≥4/≥5 for women/men indicating at-risk drinking. RESULTS The trial participation rate was 67% with higher odds of participation in younger adults (P < 0.001). Retention rates at 3 and 6 months were 85% and 81%, respectively. Higher retention was associated with older age, higher level of school education and non-smoking (all p-values ≤0.05). Low-risk drinkers were more likely to participate in the trial (P < 0.01) and in post-baseline assessments (P < 0.05) than at-risk drinkers. CONCLUSION Our data suggest that registry offices could be a suitable setting to reach people from the general population for BAI. Especially the understudied group of low-risk drinkers was well reached through BAI and showed high adherence. BAI that addresses alcohol consumers beyond those at risk may be well accepted in proactively recruited people from the general population.
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Affiliation(s)
- Caroline E Enders
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Prevention Research and Social Medicine, Institute of Community 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, Germany
| | - Christian Meyer
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Sabina Ulbricht
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Ulrich John
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Mocanu V, Cowan N, Klimas J, Ahamad K, Wood E. Modernizing Withdrawal Management Services. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ruben JP, Paul V, Nicholas AV, Devarbhavi H, Patil M, Selvam S, Mysore. V A. Nurse-conducted Brief Intervention for Alcohol Use Disorders in a Medical In-patient Setting in India - A Feasibility Study. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1901633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Vanila Paul
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
| | | | - Harshad Devarbhavi
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics & Population Health, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Ashok Mysore. V
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
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Dorey L, Lathlean J, Roderick P, Westwood G. Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways. J Adv Nurs 2021; 77:1945-1955. [PMID: 33590919 DOI: 10.1111/jan.14777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). DESIGN A longitudinal qualitative study. METHODS A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N = 12 in each pathway; purposive selection) 1-4 weeks post-detoxification and at 3 and 6 months, to identify patient experiences of these interventions. RESULTS Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. CONCLUSION Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. IMPACT Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.
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Affiliation(s)
- Lucy Dorey
- Department of Psychology, Swansea University, Swansea, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Judith Lathlean
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Paul Roderick
- Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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12
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Oxholm C, Christensen AMS, Christiansen R, Nielsen AS. Can We Talk about Alcohol for a Minute? Thoughts and Opinions Expressed by Health Professionals and Patients at a Somatic Hospital. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2020.1803168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Oxholm
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
| | | | - Regina Christiansen
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- University Function, Psychiatric Hospital, Region of Southern Denmark, Odense, Denmark
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Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res 2020; 44:2386-2400. [PMID: 33119905 DOI: 10.1111/acer.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.
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Affiliation(s)
- Kristine Lou Gargaritano
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caoimhe Murphy
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Austin B Auyeung
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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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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15
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Freyer-Adam J, Noetzel F, Baumann S, Aghdassi AA, Siewert-Markus U, Gaertner B, John U. Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention. BMC Public Health 2019; 19:1594. [PMID: 31783832 PMCID: PMC6884835 DOI: 10.1186/s12889-019-7931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. Methods Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18–64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. Results In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35–49 (67.9%) and 50–64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. Conclusions Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular. Registry clinicaltrials.gov: NCT01291693.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany. .,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.
| | - Florian Noetzel
- Clinic and Policlinic of Urology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sophie Baumann
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ali Alexander Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Ulrich John
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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16
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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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Miller P, Droste N, Egerton‐Warburton D, Caldicott D, Fulde G, Ezard N, Preisz P, Walby A, Lloyd‐Jones M, Stella J, Sheridan M, Baker T, Hall M, Shakeshaft A, Havard A, Bowe S, Staiger PK, D'Este C, Doran C, Coomber K, Hyder S, Barker D, Shepherd J. Driving change: A partnership study protocol using shared emergency department data to reduce alcohol‐related harm. Emerg Med Australas 2019; 31:942-947. [DOI: 10.1111/1742-6723.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Miller
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Nicolas Droste
- School of PsychologyDeakin University Geelong Victoria Australia
| | | | - David Caldicott
- Calvary Health Care Canberra Australian Capital Territory Australia
| | - Gordian Fulde
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Nadine Ezard
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Paul Preisz
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Andrew Walby
- St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | | | | | | | - Tim Baker
- Southwest Health Care Warrnambool Victoria Australia
| | - Michael Hall
- The Canberra Hospital and Health Service Canberra Australian Capital Territory Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales Sydney New South Wales Australia
| | - Alys Havard
- Centre for Big Data Research in HealthThe University of New South Wales Sydney New South Wales Australia
| | - Steve Bowe
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Petra K Staiger
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population HealthThe Australian National University Canberra Australian Capital Territory Australia
- The University of Newcastle Newcastle New South Wales Australia
| | - Chris Doran
- Central Queensland University Rockhampton Queensland Australia
| | - Kerri Coomber
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Shannon Hyder
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Daniel Barker
- Central Queensland University Rockhampton Queensland Australia
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18
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Making a bridge between general hospital and specialised community-based treatment for alcohol use disorder-A pragmatic randomised controlled trial. Drug Alcohol Depend 2019; 196:51-56. [PMID: 30665152 DOI: 10.1016/j.drugalcdep.2018.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
AIM To investigate if more patients in the intervention group attended specialized alcohol treatment compared with a treatment-as-usual group (TAU). METHODS Pragmatic randomized controlled trial where consecutive patients, admitted to somatic hospitals, filled out a lifestyle questionnaire with the Alcohol Use Disorder Identification Test (AUDIT) embedded. Patients scoring 8+ on AUDIT were included in the study. Included patients were randomized to either a Danish screening brief intervention and referral to treatment (SBIRT) called the Relay model or TAU depending on date of admission. The Relay group was offered a brief alcohol intervention by an outreach alcohol therapist. Patients scoring 16 points and above on the AUDIT test also received referral to alcohol treatment. Outcome was attendance at specialized outpatient alcohol treatment centres after discharge from hospital. Information on patients was gathered from municipal databases at 18 months follow-up. RESULTS A total of 3534 patients completed the questionnaire, and 609 patients (17%) scored AUDIT 8+. 48 patients were lost to follow-up, and the final sample had 561 patients. Only 33 patients (6%) attended outpatient treatment at 18-months follow-up, but significantly more patients in the Relay group sought alcohol treatment than in the TAU group (OR = 2.5 [1.2;5.2] (p = 0.017)). Number needed to treat (NNT) was 20 [95% CI 11.2;112.3]. CONCLUSION The Relay intervention was associated with more patients attending specialized treatment, but further research is needed to establish if general hospitals are an excellent platform for performing SBIRT.
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19
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L’addictologie de liaison : outils et spécificités. Encephale 2018; 44:354-362. [DOI: 10.1016/j.encep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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20
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Haberecht K, Baumann S, Bischof G, Gaertner B, John U, Freyer-Adam J. Do brief alcohol interventions among unemployed at-risk drinkers increase re-employment after 15 month? Eur J Public Health 2018; 28:510-515. [PMID: 29036439 DOI: 10.1093/eurpub/ckx142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background At-risk alcohol use is associated bi-directionally to unemployment, and decreases chances of re-employment. Brief alcohol interventions (BAI) can reduce at-risk alcohol use. This study aimed to investigate 15-month effects of BAI on unemployment among persons with at-risk alcohol use. Methods As part of the randomized controlled 'Trial on proactive alcohol interventions among job-seekers, TOPAS', 1243 18- to 64-year-old job-seekers with at-risk alcohol use were systematically recruited at three job agencies in Germany (2008/09), and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). To test the effects of ST and NST on employment status 15 months after baseline, latent growth models were calculated among those initially unemployed (n = 586). Results In all three groups, unemployment significantly decreased over 15 months (ST: odds ratio, OR = 0.06; 95% confidence interval, CI: 0.01-0.27; NST: OR = 0.04; 95% CI: 0.01-0.18; AO: OR = 0.05; 95% CI: 0.01-0.21). No intervention effects were found on unemployment. Age (P = 0.002), school education (P = 0.001), self-rated health (P = 0.04), the Alcohol Use Disorder Identification Test-Consumption score (P = 0.02) and motivation to change (P = 0.04) significantly affected the development of unemployment over time. Conclusion After 15 months, no BAI effect on unemployment was found. The mediated effect of BAIs on unemployment could be a longsome process needing longer follow-ups to be detected.
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Affiliation(s)
- Katja Haberecht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Luebeck, Luebeck, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (partner site Greifswald), Greifswald, Germany.,Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Gerke SP, Agley JD, Wilson C, Gassman RA, Forys P, Crabb DW. An Initial Assessment of the Utility of Validated Alcohol and Drug Screening Tools in Predicting 30-Day Readmission to Adult General Medicine Wards. Am J Med Qual 2018; 33:397-404. [PMID: 29345150 DOI: 10.1177/1062860617750469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have identified drug and alcohol use as risk factors for readmission using claims data, but not by using substance use screening scores. This preliminary study tested the hypothesis that prevalence of 30-day readmission would be higher among patients screening positive on the 10-item Alcohol Use Disorders Identification Test (AUDIT-10) or the 10-item Drug Abuse Screening Test (DAST-10) tools at intake than among the general patient population. Social workers screened 4708 adult inpatients using prescreening questions followed by the AUDIT-10 and/or DAST-10. Patients with positive screens were followed for readmissions within 30 days of discharge. A positive screening score on the AUDIT-10 or DAST-10 instrument at intake was associated with higher risk of readmission to the general medicine wards within 30 days; this relationship appears complex and subject to mediation. Post hoc chart review found that the majority of readmissions among patients with positive screens were not immediately attributable to substance use. Further study is needed to verify these preliminary findings.
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Affiliation(s)
- Steven P Gerke
- 1 Indiana University School of Medicine, Indianapolis, IN.,3 Eskenazi Health, Indianapolis, IN
| | - Jon D Agley
- 4 Institute for Research on Addictive Behavior, Indiana University, Bloomington, IN
| | | | - Ruth A Gassman
- 2 Indiana Prevention Resource Center, Indiana University, Bloomington, IN.,4 Institute for Research on Addictive Behavior, Indiana University, Bloomington, IN
| | - Philip Forys
- 1 Indiana University School of Medicine, Indianapolis, IN
| | - David W Crabb
- 1 Indiana University School of Medicine, Indianapolis, IN.,3 Eskenazi Health, Indianapolis, IN
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22
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Freyer CH, Morley KC, Haber PS. Alcohol use disorders in Australia. Intern Med J 2017; 46:1259-1268. [PMID: 27813358 DOI: 10.1111/imj.13237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 07/28/2016] [Indexed: 12/19/2022]
Abstract
Alcohol use disorders are common in Australia and are often unrecognised. Alcohol places a significant burden on our healthcare system by increasing the risk of injuries as well as many chronic medical conditions. Diagnosis requires a high index of suspicion and can be aided by the use of specific questionnaires, such as the Alcohol Use Disorder Identification Test-C. The current available laboratory tests are of limited sensitivity and specificity, but can nevertheless aid in the diagnosis in some circumstances. Newer tests, such as ethyl-glucuronide and phosphatidylethanol, are more sensitive and specific but are costly and not widely available. The effective management of alcohol use disorder entails psychosocial or pharmacological treatments or a combination of both. In those who cannot reduce alcohol consumption, harm reduction strategies can be applied to reduce the burden of harm to the drinkers as well as the community at large.
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Affiliation(s)
- C H Freyer
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - K C Morley
- NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - P S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Nikkola J, Laukkarinen J, Huhtala H, Sand J. The Intensity of Brief Interventions in Patients with Acute Alcoholic Pancreatitis Should be Increased, Especially in Young Patients with Heavy Alcohol Consumption. Alcohol Alcohol 2017; 52:453-459. [DOI: 10.1093/alcalc/agx023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 01/18/2023] Open
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Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, Murthy P, King M, McDaid D, Park AL, Wilson GT, Kirkwood B, Fairburn CG, Velleman R, Patel V. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet 2017; 389:186-195. [PMID: 27988144 PMCID: PMC5236065 DOI: 10.1016/s0140-6736(16)31590-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although structured psychological treatments are recommended as first-line interventions for harmful drinking, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP), a brief psychological treatment delivered by lay counsellors to patients with harmful drinking attending routine primary health-care settings. METHODS In this randomised controlled trial, we recruited male harmful drinkers defined by an Alcohol Use Disorders Identification Test (AUDIT) score of 12-19 who were aged 18-65 years from ten primary health centres in Goa, India. We excluded patients who needed emergency medical treatment or inpatient admission, who were unable to communicate clearly, and who were intoxicated at the time of screening. Participants were randomly allocated (1:1) by trained health assistants based at the primary health centres to enhanced usual care (EUC) alone or EUC combined with CAP, in randomly sized blocks of four to six, stratified by primary health centre, and allocation was concealed with use of sequential numbered opaque envelopes. Physicians providing EUC and those assessing outcomes were masked. Primary outcomes were remission (AUDIT score of <8) and mean daily alcohol consumed in the past 14 days, at 3 months. Secondary outcomes were the effect of drinking, disability score, days unable to work, suicide attempts, intimate partner violence, and resource use and costs of illness. Analyses were on an intention-to-treat basis. We used logistic regression analysis for remission and zero-inflated negative binomial regression analysis for alcohol consumption. We assessed serious adverse events in the per-protocol population. This trial is registered with the ISCRTN registry, number ISRCTN76465238. FINDINGS Between Oct 28, 2013, and July 29, 2015, we enrolled and randomly allocated 377 participants (188 [50%] to the EUC plus CAP group and 190 [50%] to the EUC alone group [one of whom was subsequently excluded because of a protocol violation]), of whom 336 (89%) completed the 3 month primary outcome assessment (164 [87%] in the EUC plus CAP group and 172 [91%] in the EUC alone group). The proportion with remission (59 [36%] of 164 in the EUC plus CAP group vs 44 [26%] of 172 in the EUC alone group; adjusted prevalence ratio 1·50 [95% CI 1·09-2·07]; p=0·01) and the proportion abstinent in the past 14 days (68 [42%] vs 31 [18%]; adjusted odds ratio 3·00 [1·76-5·13]; p<0·0001) were significantly higher in the EUC plus CAP group than in the EUC alone group, but we noted no effect on mean daily alcohol consumed in the past 14 days among those who reported drinking in this period (37·0 g [SD 44·2] vs 31·0 g [27·8]; count ratio 1·08 [0·79-1·49]; p=0·62). We noted an effect on the percentage of days abstinent in the past 14 days (adjusted mean difference [AMD] 16·0% [8·1-24·1]; p<0·0001), but no effect on the percentage of days of heavy drinking (AMD -0·4% [-5·7 to 4·9]; p=0·88), the effect of drinking (Short Inventory of Problems score AMD-0·03 [-1·93 to 1·86]; p=0.97), disability score (WHO Disability Assessment Schedule score AMD 0·62 [-0·62 to 1·87]; p=0·32), days unable to work (no days unable to work adjusted odds ratio 1·02 [0·61-1·69]; p=0.95), suicide attempts (adjusted prevalence ratio 1·8 [-2·4 to 6·0]; p=0·25), and intimate partner violence (adjusted prevalence ratio 3·0 [-10·4 to 4·4]; p=0·57). The incremental cost per additional remission was $217 (95% CI 50-1073), with an 85% chance of being cost-effective in the study setting. We noted no significant difference in the number of serious adverse events between the two groups (six [4%] in the EUC plus CAP group vs 13 [8%] in the EUC alone group; p=0·11). INTERPRETATION CAP delivered by lay counsellors plus EUC was better than EUC alone was for harmful drinkers in routine primary health-care settings, and might be cost-effective. CAP could be a key strategy to reduce the treatment gap for alcohol use disorders, one of the leading causes of the global burden among men worldwide. FUNDING Wellcome Trust.
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Affiliation(s)
- Abhijit Nadkarni
- Sangath Centre, Socorro Village, Bardez-Goa, Goa, India; London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen A Weiss
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Bhargav Bhat
- Sangath Centre, Socorro Village, Bardez-Goa, Goa, India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - G Terence Wilson
- Department of Psychology, Rutgers School of Arts and Sciences, NJ, USA
| | - Betty Kirkwood
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Richard Velleman
- Sangath Centre, Socorro Village, Bardez-Goa, Goa, India; Department of Psychology, University of Bath, Bath, UK
| | - Vikram Patel
- Sangath Centre, Socorro Village, Bardez-Goa, Goa, India; London School of Hygiene & Tropical Medicine, London, UK.
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Muncie HL. Care of the Alcoholic Patient. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.
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Affiliation(s)
- Jason P Connor
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - Paul S Haber
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, King's College London, London, UK.
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Freyer-Adam J, Baumann S, Haberecht K, Tobschall S, Schnuerer I, Bruss K, Bandelin E, John U, Gaertner B. In-person and computer-based alcohol interventions at general hospitals: reach and retention. Eur J Public Health 2016; 26:844-849. [PMID: 26748101 DOI: 10.1093/eurpub/ckv238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High reach of target populations is relevant for public health impact of interventions. Concerning intervention programs requiring multiple contacts, little is known about how many persons may be kept in the intervention program over multiple time points. The aim of this study was to investigate (i) the reach of general hospital inpatients with at-risk alcohol use through screening and brief intervention and (ii) whether their continued intervention participation after hospital discharge differs by in-person vs. computer-based intervention (CO) delivery. METHODS As part of a randomized controlled trial, general hospital inpatients aged 18-64 years were screened for at-risk alcohol use on 13 wards. Participants were allocated to in-person intervention (PE), CO and assessment only. Both interventions were provided on site, and 1 and 3 months after baseline. RESULTS Ninety-two percent of all eligible inpatients ( N: = 6251) completed the screening. Eighty-one percent ( N: = 961) of the screening-positives participated in the trial and received their allocated intervention. At months 1 and 3, interventions were delivered to 83 and 79% of the CO participants and to 74 and 64% of the PE participants. The delivery of CO and PE required an average of 5.2 and 7.7 contact attempts per delivered intervention, respectively. CONCLUSION General hospital inpatients with at-risk alcohol use were well reached through proactive interventions. COs may result in higher retention rates over 1 and 3 months and may require less contact attempts than PEs. Public health efforts that aim to achieve high intervention retention should consider proactive COs.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany .,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Katja Haberecht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Stefanie Tobschall
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Inga Schnuerer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Kornelia Bruss
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Elke Bandelin
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research, Partner site Greifswald, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Barrio P, Gual A. Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials. Patient Prefer Adherence 2016; 10:1823-1845. [PMID: 27695301 PMCID: PMC5029836 DOI: 10.2147/ppa.s109641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ISSUES Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders. APPROACH A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients' own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge. KEY FINDINGS In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance. IMPLICATIONS PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders.
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Affiliation(s)
- Pablo Barrio
- Neurosciences Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
- Correspondence: Pablo Barrio, Neurosciences Institute, Hospital Clinic, IDIBAPS, Carrer de Villlarroel 170, 08036 Barcelona, Spain, Tel +34 932 275 400 ext 3167, Email
| | - Antoni Gual
- Neurosciences Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
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Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015; 110:1404-15. [PMID: 25913697 PMCID: PMC4753046 DOI: 10.1111/add.12950] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
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Affiliation(s)
- Joseph E. Glass
- School of Social Work, University of Wisconsin-Madison, Madison, WI
| | | | - Byron J. Powell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian E. Perron
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Randall T. Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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Beagon C, Bhatt N, Donnelly S, Egan M, McKay A, Mehigan B, Conlon K, Ridgway P. The Impact of Social Work Intervention in Alcohol-Induced Pancreatitis in Ireland: a Single-Center Experience. Alcohol Alcohol 2015; 50:438-43. [DOI: 10.1093/alcalc/agv040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
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Simioni N, Cottencin O, Rolland B. Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients with Alcohol Use Disorders from Somatic Inpatient Settings: A Systematic Review. Alcohol Alcohol 2015; 50:420-9. [DOI: 10.1093/alcalc/agv017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
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Muncie HL. Care of the Alcoholic Patient. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_66-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chiappetta V, García-Rodríguez O, Jin CJ, Secades-Villa R, Blanco C. Predictors of quit attempts and successful quit attempts among individuals with alcohol use disorders in a nationally representative sample. Drug Alcohol Depend 2014; 141:138-44. [PMID: 24948080 DOI: 10.1016/j.drugalcdep.2014.05.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study sought to identify predictors of attempting to quit and of successfully quitting alcohol abuse or dependence in the general population. METHODS Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS Approximately 10% of individuals with alcohol abuse and 18% of those with dependence attempted to quit over the three year follow-up period. Of those who tried, 38% of individuals with abuse and 30% of those with dependence successfully quit. Among individuals with alcohol abuse or dependence, being single, younger than 40 years old, having low income, a co-occurring psychiatric disorder and greater number of dependence symptoms increased the likelihood of attempting to quit. Among individuals with alcohol abuse, male gender and low educational attainment further increased the odds of quit attempts. However, greater severity of alcohol use disorder, having a co-occurring drug use disorder and greater number of psychiatric disorders decreased the odds of success among individuals with alcohol abuse, while female gender, being married and older than 40 years old increased the odds of success. Among individuals with alcohol dependence, having nicotine dependence, greater number of psychiatric disorders and personality disorders decreased the odds of success. CONCLUSIONS Predictors of attempts to quit are different and sometimes opposite from those leading to successful quitting probably indicating that some factors that increase motivation may decrease ability to quit. These findings may help in the development of more targeted and effective interventions for alcohol use disorders.
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Affiliation(s)
- Viviana Chiappetta
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
| | - Olaya García-Rodríguez
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA; Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
| | - Chelsea J Jin
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
| | - Roberto Secades-Villa
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA; Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
| | - Carlos Blanco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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Bergen H, Hawton K, Webb R, Cooper J, Steeg S, Haigh M, Ness J, Waters K, Kapur N. Alcohol-related mortality following self-harm: a multicentre cohort study. JRSM Open 2014; 5:2054270414533326. [PMID: 25289146 PMCID: PMC4100241 DOI: 10.1177/2054270414533326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess alcohol-related premature death in people who self-harm compared to the general population, including variation by socioeconomic deprivation. Design A retrospective longitudinal cohort analysis from the Multicentre Study of self-harm in England, 1 January 2000 to 31 December 2010, with cause-specific mortality follow-up through to 31 December 2012. Setting Six emergency departments in Oxford, Manchester and Derby. Participants All individuals aged 15 years or more who presented with self-harm (n = 39,014) to general hospital emergency departments, together with follow-up mortality information from the Data Linkage Service of the Health and Social Care Information Centre. Main outcome measures Standardised mortality ratios (observed/expected number of deaths: SMRs) and mean number of years of life lost (YLL) were estimated for alcohol-related mortality. Patients’ characteristics and clinical management following self-harm were also examined. Results After 7.5 years’ (median) follow-up, 2695 individuals (6.9%) had died, significantly more males (9.5%) than females (5.0%), including 307 (11.4%) from alcohol-related causes. Alcohol-related death was more frequent than expected in both males (SMR 8.5, 95% CI 7.3 to 9.8) and females (11.6, 9.8 to 13.7), equating to 33.7 YLL (95% CI 32.4 to 35.0) in males and 38.1 YLL (36.6 to 39.6) in females. It was not associated with area-level socioeconomic deprivation. Alcohol-related death was associated with unemployed/sick/disabled status, alcohol use during self-harm, referral to drug/alcohol services and lack of psychosocial assessment following self-harm. Conclusions Hospital-presenting self-harm patients should receive assessment following self-ham according to national guidance to enable early identification and treatment of alcohol problems.
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Affiliation(s)
- Helen Bergen
- Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK
| | - Roger Webb
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Jayne Cooper
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Sarah Steeg
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Matthew Haigh
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK ; Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Navneet Kapur
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
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Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis. PLoS One 2014; 9:e99912. [PMID: 24937483 PMCID: PMC4061051 DOI: 10.1371/journal.pone.0099912] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/19/2014] [Indexed: 01/16/2023] Open
Abstract
Background Alcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions. Methods Systematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment. Findings We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13–0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056). Conclusions Internet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success.
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Droste N, Miller P, Baker T. Review article: Emergency department data sharing to reduce alcohol-related violence: A systematic review of the feasibility and effectiveness of community-level interventions. Emerg Med Australas 2014; 26:326-35. [DOI: 10.1111/1742-6723.12247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolas Droste
- School of Psychology; Deakin University; Geelong Victoria Australia
| | - Peter Miller
- School of Psychology; Deakin University; Geelong Victoria Australia
| | - Tim Baker
- School of Medicine; Deakin University; Warrnambool Victoria Australia
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Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol 2014; 43:906-19. [DOI: 10.1093/ije/dyu018] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Heather N. Interpreting null findings from trials of alcohol brief interventions. Front Psychiatry 2014; 5:85. [PMID: 25076917 PMCID: PMC4100216 DOI: 10.3389/fpsyt.2014.00085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/03/2014] [Indexed: 12/03/2022] Open
Abstract
The effectiveness of alcohol brief intervention (ABI) has been established by a succession of meta-analyses but, because the effects of ABI are small, null findings from randomized controlled trials are often reported and can sometimes lead to skepticism regarding the benefits of ABI in routine practice. This article first explains why null findings are likely to occur under null hypothesis significance testing (NHST) due to the phenomenon known as "the dance of the p-values." A number of misconceptions about null findings are then described, using as an example the way in which the results of the primary care arm of a recent cluster-randomized trial of ABI in England (the SIPS project) have been misunderstood. These misinterpretations include the fallacy of "proving the null hypothesis" that lack of a significant difference between the means of sample groups can be taken as evidence of no difference between their population means, and the possible effects of this and related misunderstandings of the SIPS findings are examined. The mistaken inference that reductions in alcohol consumption seen in control groups from baseline to follow-up are evidence of real effects of control group procedures is then discussed and other possible reasons for such reductions, including regression to the mean, research participation effects, historical trends, and assessment reactivity, are described. From the standpoint of scientific progress, the chief problem about null findings under the conventional NHST approach is that it is not possible to distinguish "evidence of absence" from "absence of evidence." By contrast, under a Bayesian approach, such a distinction is possible and it is explained how this approach could classify ABIs in particular settings or among particular populations as either truly ineffective or as of unknown effectiveness, thus accelerating progress in the field of ABI research.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University , Newcastle upon Tyne , UK
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Gordon AJ, Bertholet N, McNeely J, Starrels JL, Tetrault JM, Walley AY. 2013 Update in addiction medicine for the generalist. Addict Sci Clin Pract 2013; 8:18. [PMID: 24499640 PMCID: PMC3819258 DOI: 10.1186/1940-0640-8-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.
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Affiliation(s)
- Adam J Gordon
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Joanna L Starrels
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Shiles CJ, Canning UP, Kennell-Webb SA, Gunstone CM, Marshall EJ, Peters TJ, Wessely SC. Randomised controlled trial of a brief alcohol intervention in a general hospital setting. Trials 2013; 14:345. [PMID: 24148799 PMCID: PMC4016505 DOI: 10.1186/1745-6215-14-345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background The evidence suggests that brief alcohol-focused interventions, directed at hazardous and harmful drinkers in non-specialist settings such as primary care are effective in reducing alcohol consumption. However, there is a need for further research in the hospital setting. This is a randomised controlled trial to investigate the effectiveness of a 10-minute brief intervention amongst 'at risk’ drinkers admitted to general hospital wards. Unlike some previous trials, this trial is randomised, used blinded assessors, includes an intention-to-treat analysis, included female subjects and excluded people with alcohol dependence. Methods A total of 250 'at risk’ drinkers admitted to King’s College Hospital were identified using the Alcohol Use Disorders Identification Test (AUDIT). Some 154 subjects entered the study and were randomly allocated to the control and intervention groups. Subjects in the control group received no advice about their drinking whilst subjects in the intervention group received 10 minutes of simple advice on reducing alcohol consumption. Recruitment took place between 1995 and 1997. The primary outcome was the AUDIT questionnaire at 12 months. Secondary outcomes were a previous week’s Drinks Diary, questionnaires (General Health Questionnaire, Alcohol Problems Questionnaire and the Severity of Alcohol Dependence Questionnaire) and laboratory blood tests (gamma glutamyl transferase, mean cell volume and haemoglobin). Results At 3-month and 12-month follow-up, all participants were included in the intention-to-treat analysis. At both time points there was no evidence of an intervention effect that could be attributed to the brief intervention. Both the intervention and control groups had an improved AUDIT score and reduced levels of alcohol consumption as measured by a subjective Drinks Diary at 3 months which was maintained at 12 months. Conclusions This study has added further evidence on brief interventions in the hospital setting. In contrast to the recent Cochrane review by McQueen et al., the results of this study do not support the effectiveness of a brief alcohol intervention in general hospital wards. However our study was underpowered and there were flaws in the statistical analyses, and these limitations temper the strength of our conclusions.
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Affiliation(s)
| | | | | | | | - E Jane Marshall
- Out-Patient Department, Maudsley Hospital, South London and Maudsley, NHS Foundation Trust, Alcohol Unit, C/O Room 40, Denmark Hill, London SE5 8AZ, UK.
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Mdege ND, Chindove S. Effectiveness of tobacco use cessation interventions delivered by pharmacy personnel: a systematic review. Res Social Adm Pharm 2013; 10:21-44. [PMID: 23743504 DOI: 10.1016/j.sapharm.2013.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable morbidity and mortality. Implementation of tobacco use cessation interventions however requires strategies that reach large proportions of the population. Pharmacy personnel are therefore a potential human resource for delivering tobacco use cessation interventions. OBJECTIVE This review aimed to identify, describe and synthesis currently available evidence on the effectiveness of tobacco use cessation interventions delivered by pharmacy personnel. METHODS The following electronic databases were searched for studies published until May 2012: MEDLINE, EMBASE, PSYCINFO, Cochrane Library, Web of Knowledge and the Current Controlled Trials Register. This review considered controlled clinical trials and randomized controlled trials, which were comparing any pharmacy personnel delivered tobacco use cessation intervention to no treatment, usual care or other active treatments. The outcomes of interest were: abstinence (e.g., point prevalence; continuous abstinence) and relapse (e.g., time to relapse) as measured by the respective studies. The results were not pooled due to high levels of clinical heterogeneity. RESULTS Ten eligible studies with a total of 20,133 participants were identified. Results suggest pharmacy personnel delivered non-pharmacological interventions offering behavioral counseling or support for tobacco use cessation could be beneficial, particularly from 6 months follow-up onwards. Combining these non-pharmacological with pharmacological interventions could also be beneficial. The results for the effectiveness of nicotine replacement therapy (NRT) were mixed with some findings suggesting intervention benefits, and others suggesting no clear benefit. CONCLUSIONS Pharmacy personnel-delivered non-pharmacological tobacco use cessation interventions offering behavioral counseling or support, and those combining these non-pharmacological interventions with NRT/pharmacological approaches, are potentially effective. No clear benefit has been demonstrated on pharmacy personnel-delivered NRT interventions. However, these findings are based on a very limited number of studies and hence more evidence is needed before more robust conclusions can be made.
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Affiliation(s)
- Noreen Dadirai Mdege
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
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