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Brown RT, Zamora K, Rizzo A, Spar MJ, Fung KZ, Santiago L, Campbell A, Nicosia FM. Improving measurement of functional status among older adults in primary care: A pilot study. PLoS One 2024; 19:e0303402. [PMID: 38739582 PMCID: PMC11090365 DOI: 10.1371/journal.pone.0303402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.
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Affiliation(s)
- Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathy Z. Fung
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lea Santiago
- San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Annie Campbell
- Martinez VA Medical Center, Martinez, California, United States of America
| | - Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, United States of America
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So R, Kariyama K, Oyamada S, Matsushita S, Nishimura H, Tezuka Y, Sunami T, Furukawa TA, Kawaguchi M, Kobashi H, Nishina S, Otsuka Y, Tsujimoto Y, Horie Y, Yoshiji H, Yuzuriha T, Nouso K. Prevalence of hazardous drinking and suspected alcohol dependence in Japanese primary care settings. Gen Hosp Psychiatry 2024; 89:8-15. [PMID: 38657355 DOI: 10.1016/j.genhosppsych.2024.04.002] [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: 02/17/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE We aimed to assess the prevalence of hazardous drinking and potential alcohol dependence among Japanese primary care patients, and their readiness to change and awareness of others' concerns. METHODS From July to August 2023, we conducted a multi-site cross-sectional study as a screening survey for participants in a cluster randomized controlled trial. The trial included outpatients aged 20-74 from primary care clinics. Using the Alcohol Use Disorders Identification Test (AUDIT) alongside a self-administered questionnaire, we evaluated the prevalence of hazardous drinking and suspected alcohol dependence, patients' readiness to change, and their awareness of others' concerns. RESULTS Among the 1388 participants from 18 clinics, 22% (95% confidence interval (CI): 20% to 24%) were identified as engaging in hazardous drinking or suspected of being alcohol dependent. As the AUDIT scores increased, so did their readiness to change. However, only 22% (95%CI: 16% to 28%) of those with scores ranging from 8 to 14 reported that others, including physicians, had expressed concerns about their drinking during the past year. For those with scores of 15 or higher, the figure was 74%. CONCLUSIONS This study underscores the need for universal or high-risk alcohol screening and brief intervention in Japanese primary care settings. Trial registry UMIN-CTR (https://www.umin.ac.jp/ctr/) (UMIN000051388).
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Affiliation(s)
- Ryuhei So
- Okayama Psychiatric Medical Center, Okayama, Japan; CureApp, Inc., Tokyo, Japan; Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Kazuya Kariyama
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | | | - Sachio Matsushita
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Hiroki Nishimura
- Okayama Psychiatric Medical Center, Okayama, Japan; CureApp, Inc., Tokyo, Japan
| | - Yukio Tezuka
- Department of Psychiatry, Okinawa Rehabilitation Center Hospital, Okinawa, Japan
| | | | - Toshi A Furukawa
- Office of Institutional Advancement and Communications, Kyoto University, Kyoto, Japan; Kyoto University, Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | | | - Haruhiko Kobashi
- Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Sohji Nishina
- Department of Gastroenterology and Hepatology, Kawasaki Medical School, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasushi Tsujimoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Oku Medical Clinic, Osaka, Japan
| | | | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takefumi Yuzuriha
- National Hospital Organization Hizen Psychiatric Medical Center, Saga, Japan; Chikugo Yoshii Cocoro Hospital, Fukuoka, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
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Pérula-Jiménez C, Romero-Rodríguez E, Parras-Rejano JM, de la Rubia AG, Gómez JB, de Torres LAP. Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing. Aten Primaria 2024; 56:102835. [PMID: 38086313 PMCID: PMC10726214 DOI: 10.1016/j.aprim.2023.102835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING PC of the Andalusian Health Service. PARTICIPANTS The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.
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Affiliation(s)
- Celia Pérula-Jiménez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía Hospital, University of Cordoba, Cordoba, Spain; Montoro Health Center, Andalusian Health Service, Cordoba, Spain
| | - Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía Hospital, University of Cordoba, Cordoba, Spain; Multiprofessional Teaching Unit of Family and Community Care of Cordoba, Spain
| | - Juan Manuel Parras-Rejano
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía Hospital, University of Cordoba, Cordoba, Spain; Sector Sur Health Center, Andalusian Health Service, Cordoba, Spain
| | - Ana González de la Rubia
- Cordoba and Guadalquivir Health District, Cordoba, Spain; General Emergencies Unit of the Regional University Hospital, Malaga, Spain
| | | | - Luis Angel Pérula de Torres
- Improvement and Evaluation Group, Program of Preventive Activities and Health Promotion (PAPPS), Semfyc, Barcelona, Spain.
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Mah SS, Teare GF, Law J, Adhikari K. Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research. BMC Health Serv Res 2024; 24:228. [PMID: 38383382 PMCID: PMC10882928 DOI: 10.1186/s12913-024-10676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Screening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings. OBJECTIVE To explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR). METHODS We conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data. RESULTS A total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients' readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors. CONCLUSION The CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.
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Affiliation(s)
- Sharon S Mah
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Gary F Teare
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Law
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Kamala Adhikari
- Cancer Prevention and Screening Innovation (CPSI), Public Health Evidence and Innovation (PHEI), Provincial Population & Public Health, Alberta Health Services, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Pérula-Jiménez C, Romero-Rodríguez E, Fernández-Solana J, Fernández-García JÁ, Parras-Rejano JM, Pérula-de Torres LÁ, González-de la Rubia A, González-Santos J. Primary Care Professionals' Empathy and Its Relationship to Approaching Patients with Risky Alcohol Consumption. Healthcare (Basel) 2024; 12:262. [PMID: 38275543 PMCID: PMC10815215 DOI: 10.3390/healthcare12020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center's scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.
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Affiliation(s)
- Celia Pérula-Jiménez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Montoro Health Center, Andalusian Health Service, 14600 Cordoba, Spain
| | - Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Cordoba and Guadalquivir Health District, 14001 Cordoba, Spain;
| | | | - José Ángel Fernández-García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14011 Cordoba, Spain; (C.P.-J.); (E.R.-R.); (J.Á.F.-G.)
- Villarrubia Center, 14005 Cordoba, Spain
| | - Juan Manuel Parras-Rejano
- Cordoba and Guadalquivir Health District, 14001 Cordoba, Spain;
- Huerta de la Reina Health Center, Andalusian Health Service, 14600 Cordoba, Spain
| | - Luis Ángel Pérula-de Torres
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPS-ISCIII), 08007 Zaragoza, Spain;
- Program of Preventive Activities and Health Promotion (PAPPS-semFYC), 08009 Barcelona, Spain
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Baltes A, Horton D, Trevino C, Quanbeck A, Deyo B, Nicholas C, Brown R. Feasibility of implementing a screening tool for risk of opioid misuse in a trauma surgical population. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231226193. [PMID: 38322804 PMCID: PMC10838038 DOI: 10.1177/26334895231226193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background As the opioid crisis continues to affect communities across the United States, new interventions for screening and prevention are needed to mitigate its impact. Mental health diagnoses have been identified as a risk factor for opioid misuse, and surgical populations and injury survivors are at high risk for prolonged opioid use and misuse. This study investigated the implementation of a novel opioid risk screening tool that incorporated putative risk factors from a recent study in four trauma units across Wisconsin. Method The screening tool was implemented across a 6-month period at four sites. Data was collected via monthly meeting notes and "Plan, Do, Study, Act" (PDSA) forms. Following implementation, focus groups reflected on the facilitators and barriers to implementation. Meeting notes, PDSA forms, and focus group data were analyzed using the consolidated framework for implementation research, followed by thematic analyses, to generate themes surrounding the facilitators and barriers to implementing an opioid misuse screener. Results Implementation facilitators included ensuring patient understanding of the screener, minimizing staff burden from screening, and educating staff to encourage engagement. Barriers included infrastructure limitations that prevented seamless administration of the screener within current workflows, overlap of the screener with existing measures, and lack of guidance surrounding treatment options corresponding to risk. Recommended solutions to address barriers include careful timing of screener administration, accommodating workflows, integration of the screening tool within the electronic health record, and evidence-based interventions guided by screener results. Conclusion Four trauma centers across Wisconsin successfully implemented a pilot opioid misuse screening tool. Trauma providers and unit staff members believe that this tool would be a beneficial addition to their repertoire if their recommendations were adopted. Future research should refine opioid misuse risk factors and ensure screening items are well-validated with psychometric research supporting treatment responses to screener-indicated risk categories.
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Affiliation(s)
- Amelia Baltes
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Horton
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Colleen Trevino
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Brienna Deyo
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christopher Nicholas
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Randall Brown
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Nadkarni A, Gaikwad L, Sequeira M, Velleman R, D'souza J, Hoble A, Haldankar R, Murthy P, Naughton F. Evaluation of Feasibility and Acceptability of a Text-Messaging Intervention for Tobacco Cessation in India. Nicotine Tob Res 2024; 26:72-78. [PMID: 37638548 PMCID: PMC10734385 DOI: 10.1093/ntr/ntad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/26/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION The aim of our study was to assess the feasibility and acceptability of a brief behavioral intervention for tobacco cessation delivered via mobile phone text messaging in India. AIMS AND METHODS We conducted an uncontrolled intervention cohort study in adult current users of tobacco. The participants received intervention messages on their mobile phones for eight weeks. We collected qualitative data about participants' perceptions of intervention delivery and receipt, acceptability, and feasibility of the intervention. The outcomes measured at 3 months post-recruitment were self-reported 7- and 28-day point-prevalence abstinence, and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk categories for tobacco-low (0-3), moderate (4-26), and high (≥27). RESULTS We recruited 26 eligible participants, and 22 completed the outcome assessments. The participants generally perceived the intervention content to be simple to access and useful in facilitating a change in tobacco use. None of the participants indicated that they wanted to discontinue receiving the intervention messages. Some suggestions for enhancing acceptability included supplementing text messaging with more intensive counseling and the use of multimedia content. Eighteen percent of participants reported abstinence in the past 7 and 28 days. A greater proportion of those who used smokeless tobacco were abstinent at follow-up compared to those who smoked (42.9% vs. 6.7%; p = .04). CONCLUSIONS If effective, simple and low-cost mobile phone text messaging can be used to deliver interventions for tobacco use, and has the potential to be scaled up so it can be delivered to populations of smokers interested in receiving cessation support. IMPLICATIONS Our study is an important step towards the development of a contextually relevant intervention suited for low- and middle-income countries and which is responsive to the needs of both those who use smoked and smokeless tobacco. If found to be effective, our intervention would be a scalable solution to overcome the human resource related barrier to accessing tobacco cessation services in low resource settings.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Addictions and Related Research Group (ARG), Sangath, India
| | - Leena Gaikwad
- Addictions and Related Research Group (ARG), Sangath, India
| | | | - Richard Velleman
- Addictions and Related Research Group (ARG), Sangath, India
- Department of Psychology, University of Bath, Bath, UK
| | | | - Ankita Hoble
- Addictions and Related Research Group (ARG), Sangath, India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
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Kruithof PJ, McGovern W, Haighton C. "I Genuinely Believe This Is the Most Stigmatised Group within the Social Care Sector"-Health and Social Care Professionals' Experiences of Working with People with Alcohol-Related Brain Damage: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:10. [PMID: 38276798 PMCID: PMC10815022 DOI: 10.3390/ijerph21010010] [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: 11/05/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Appropriate diagnosis, treatment and care contribute to better service engagement, improvements to wellbeing, cost savings and reductions in morbidity and mortality for people with alcohol-related brain damage. In Northeast England, large amounts of alcohol are consumed; this is reflected in the number of alcohol-related deaths in the region. However, the pathway for people with alcohol-related brain damage to receive diagnosis, treatment and care is unknown and could be unwittingly influenced by stigma. Qualitative, in-depth, semi-structured interviews were completed with 25 health and social care professionals from organizations involved with people with alcohol-related brain damage recruited via snowball sampling. Interviews were recorded, transcribed verbatim, coded, and analysed. People with alcohol-related brain damage were found to be stigmatised by both society and professionals, inhibiting their entry into services. Therefore, alcohol-related brain damage remains underdiagnosed and misdiagnosed. There was found to be no dedicated service; silos with revolving doors and underfunded generic care with long waiting lists typically exclude those with alcohol-related or neurological problems. Reducing stigmatising processes associated with alcohol-related brain damage could counteract professionals' reluctance to provide care.
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Affiliation(s)
| | | | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK; (P.J.K.); (W.M.)
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Scharer JL, Gass JC, Shepardson RL, Maisto SA, Funderburk JS. Factors Influencing Patient Receptivity to Brief Alcohol Interventions in Primary Care: An Application of Conjoint Analysis. Subst Use Misuse 2023; 59:90-96. [PMID: 37791686 DOI: 10.1080/10826084.2023.2262008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity. Objectives: This study aimed to identify the treatment preferences of primary care patients who screened positive for hazardous alcohol use and to evaluate factors that may influence patients' receptivity to BAIs delivered in primary care. We conducted a mailed survey of primary care patients (N = 245) who screened positive for hazardous alcohol use on annual screening measures based on electronic medical record data. Patients completed measures assessing treatment preferences and a conjoint analysis questionnaire designed to evaluate the relative importance of three factors (focus of the BAI, tailoring of the BAI, and familiarity with the provider delivering the BAI) for patient receptivity. Results: Conjoint analysis results revealed that familiarity with provider (with patients preferring BAIs delivered by providers they have previously met) was the most important factor in predicting patients' receptivity to BAIs. Additionally, patients preferred to discuss alcohol use in the context of another concern (focus of the BAI) and preferred personalized information tailored based on their specific health concerns (tailoring of the BAI), although these factors were not statistically significant when accounting for familiarity with provider. Conclusions: Findings of the present study have potential to inform future research on implementation of BAIs.
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Affiliation(s)
- Jacob L Scharer
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
| | - Julie C Gass
- VA Center for Integrated Healthcare, VA Western New York Healthcare System (116N), Buffalo, New York, USA
- Department of Psychology, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Robyn L Shepardson
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jennifer S Funderburk
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
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11
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Leaks K, Norden-Krichmar T, Brody JP. Predicting moderate drinking behaviors in National Health and Nutrition Examination Survey participants using biochemical and demographical factors with machine learning. Alcohol 2023; 113:1-10. [PMID: 37543050 DOI: 10.1016/j.alcohol.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/26/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
Recent studies revealed that any amount of alcohol consumption is an overall health detriment to multiple populations, contrary to popular beliefs. In addition, very few alcohol use studies utilized machine learning methods to compare the biological health of moderate drinkers compared to those that abstain from alcohol consumption, opting instead to focus on binge drinking and heavy drinking. Using participant data of multiple factor types from the National Health and Nutrition Examination Survey, we created prediction models with stacked ensembles and gradient boosting models. Machine learning models were used to identify which factors most enabled the prediction of moderate drinking behaviors. Our combined factor runs produced a cross-validation area under the curve (AUC) of 0.929 and a validation area under the curve of 0.806. Runs that only included biochemical or demographical factors received cross-validation AUC values of 0.825 and 0.925, and validation AUC values of 0.757 and 0.783, respectively. The top predictive factors for our machine learning runs, including gamma glutamyl transferase, gender, iron levels, and cigarette and marijuana usage, corroborate past studies that link those factors to alcohol consumption. Our findings identified key differences in the biological health of moderate drinkers compared to those that abstain from drinking. These results reveal a need to further explore the health effects of moderate drinking, especially for vulnerable populations.
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Affiliation(s)
- Kalan Leaks
- Department of Biomedical Engineering, University of California, Irvine 3120 Natural Sciences II, Irvine, CA 92697-2715, United States
| | - Trina Norden-Krichmar
- Department of Epidemiology & Biostatistics, University of California, Irvine, 856 Health Sciences Quad, Suite 3400, Irvine, CA 92617, United States
| | - James P Brody
- Department of Biomedical Engineering, University of California, Irvine 3120 Natural Sciences II, Irvine, CA 92697-2715, United States.
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12
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Polak K, Haug NA, Dillon P, Svikis DS. Substance Use Disorders in Women. Psychiatr Clin North Am 2023; 46:487-503. [PMID: 37500246 DOI: 10.1016/j.psc.2023.04.006] [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] [Indexed: 07/29/2023]
Abstract
Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.
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Affiliation(s)
- Kathryn Polak
- Department of Psychiatry, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA.
| | - Nancy A Haug
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA
| | - Pamela Dillon
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 East Clay Street, Richmond, VA 23298, USA
| | - Dace S Svikis
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA 23284, USA
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13
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Nicosia FM, Zamora K, Rizzo A, Spar MJ, Silvestrini M, Brown RT. Using multiple qualitative methods to inform intervention development: Improving functional status measurement for older veterans in primary care settings. PLoS One 2023; 18:e0290741. [PMID: 37616266 PMCID: PMC10449158 DOI: 10.1371/journal.pone.0290741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Functional status, or the ability to perform activities of daily living, is central to older adults' health and quality of life. However, health systems have been slow to incorporate routine measurement of function into patient care. We used multiple qualitative methods to develop a patient-centered, interprofessional intervention to improve measurement of functional status for older veterans in primary care settings. We conducted semi-structured interviews with patients, clinicians, and operations staff (n = 123) from 7 Veterans Health Administration (VHA) Medical Centers. Interviews focused on barriers and facilitators to measuring function. We used concepts from the Consolidated Framework for Implementation Science and sociotechnical analysis to inform rapid qualitative analyses and a hybrid deductive/inductive approach to thematic analysis. We mapped qualitative findings to intervention components. Barriers to measurement included time pressures, cumbersome electronic tools, and the perception that measurement would not be used to improve patient care. Facilitators included a strong interprofessional environment and flexible workflows. Findings informed the development of five intervention components, including (1) an interprofessional educational session; (2) routine, standardized functional status measurement among older patients; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment; and (5) tailored reports on functional status for clinicians and operations leaders. These findings show how qualitative methods can be used to develop interventions that are more responsive to real-world contexts, increasing the chances of successful implementation. Using a conceptually-grounded approach to intervention development has the potential to improve patient and clinician experience with measuring function in primary care.
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Affiliation(s)
- Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Molly Silvestrini
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Solovei A, Mercken L, Jané-Llopis E, Bustamante I, Evers S, Gual A, Medina P, Mejía-Trujillo J, Natera-Rey G, O’Donnell A, Pérez-Gómez A, Piazza M, de Vries H, Anderson P. Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol. Health Promot Int 2023; 38:daab192. [PMID: 34849866 PMCID: PMC10439512 DOI: 10.1093/heapro/daab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, Toronto, Canada
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Antoni Gual
- Addictions Unit. Psychiatry Dept. Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos. Instituto Carlos III, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Phillips AZ, Karriker-Jaffe KJ, Bensley KMK, Subbaraman MS, Delk J, Mulia N. Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough? Alcohol Clin Exp Res 2023; 47:1390-1405. [PMID: 37421544 PMCID: PMC10524486 DOI: 10.1111/acer.15102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND We investigate whether living in a state that expanded Medicaid eligibility is associated with receiving alcohol screening and brief counseling among nonelderly, low-income adults and a subgroup with chronic health conditions caused or exacerbated by alcohol use. METHOD Data are from the 2017 and 2019 Behavioral Risk Factor Surveillance System (N = 15,743 low-income adults; n = 7062 with a chronic condition). We used propensity score-weighted, covariate-adjusted, modified Poisson regression to estimate associations between residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling. Models estimated associations in the overall sample and chronic conditions subsample, as well as differential associations across sex, race, and ethnicity using interaction terms. RESULTS Living in a state that expanded Medicaid eligibility was associated with being asked whether one drank (prevalence ratio (PR) = 1.15, 95% confidence interval (CI) = 1.08, 1.22), but not with further alcohol screening, guidance about harmful drinking, or advice to reduce drinking. Among individuals with alcohol-related chronic conditions, expansion state residence was associated with being asked about drinking (PR = 1.13, 95% CI = 1.05, 1.20) and, among past 30-day drinkers with chronic conditions, being asked how much one drank (PR = 1.28, 95% CI = 1.04, 1.59) and about binge drinking (PR = 1.43, 95% CI = 1.03, 1.99). Interaction terms suggest that some associations differ by race and ethnicity. CONCLUSIONS Living in a state that expanded Medicaid is associated with a higher prevalence of receiving some alcohol screening at a check-up in the past 2 years among low-income residents, particularly among individuals with alcohol-related chronic conditions, but not with the receipt of high-quality screening and brief counseling. Policies may have to address provider barriers to delivery of these services in addition to access to care.
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Affiliation(s)
- Aryn Z. Phillips
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lakeshore Drive Suite 1400, Chicago, IL 60611, USA
- University of Maryland School of Public Health, Department of Health Policy and Management, 4200 Valley Drive, College Park, MD 20742, USA
| | | | - Kara M. K. Bensley
- Bastyr University, Department of Public Health, 1400 Juanita Drive NE, Kenmore, WA 98028
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
| | - Meenakshi S. Subbaraman
- Public Health Institute, Behavioral Health and Recovery Studies, 555 12 Street Suite 600, Oakland, CA 94607, USA
| | - Joanne Delk
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
| | - Nina Mulia
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
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16
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Sivertsen DM, Andersen KV, Becker U, Lisby M, Andersen O, Brünes N, Kirk JW. Acceptability Among Frontline Staff Toward Distributing an Anonymous Alcohol Survey in Emergency Departments: A Mixed Methods Study. J Addict Nurs 2023; 34:E53-E64. [PMID: 37669345 PMCID: PMC10510809 DOI: 10.1097/jan.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
ABSTRACT Emergency departments (EDs) serve as the front line when patients encounter the hospital system. Limited data are available of patients' alcohol habits collected during Danish ED visits, and no studies have, to our knowledge, examined frontline staffs' (registered nurses and medical secretaries) acceptability to deliver anonymous alcohol surveys to patients. We aimed at examining the proportion of survey respondents and the prevalence of patients' alcohol habits and also exploring frontline staff acceptability of the distribution of an anonymous survey regarding patients' alcohol habits in EDs. Intendedly, all eligible patients ≥18 years old entering two EDs in March 2019 should receive a survey based on the Alcohol Use Disorder Identification Test. The study was an explanatory, sequential, mixed methods design, and results were analyzed with descriptive statistics and a deductive content analysis based on the theoretical framework of acceptability. In total, 15% (n = 1,305) of the total 8,679 patients in the EDs returned the survey. Qualitative analysis of interviews (n = 31) with staff showed that they had been reluctant to distribute the survey primarily because of ethical concerns of anonymity, freedom of choice, and being nonjudgmental toward patients. Hence, patients with no obvious alcohol problems were more likely to receive the survey. Still, we found that 23% of the respondents had an Alcohol Use Disorder Identification Test score ≥ 8. Results indicate that frontline staffs' recognition of patients' alcohol use is inadequate, and findings show a low degree of acceptability among staff to deliver an anonymous survey, which is in line with earlier described barriers toward screening activities in EDs.
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17
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A blended model to support brief interventions in primary care: A qualitative study of usability and acceptability of HealthEir in community pharmacy. Res Social Adm Pharm 2023; 19:807-820. [PMID: 36858904 DOI: 10.1016/j.sapharm.2023.02.008] [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: 06/14/2022] [Revised: 12/12/2022] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Brief interventions for lifestyle behaviour change are effective health promotion interventions. Primary care settings, including pharmacies, are the most frequently visited healthcare facilities and are well placed to provide brief health interventions. However, despite the evidence-based and policy guidance, barriers to brief interventions have limited their implementation. OBJECTIVES This study aimed to explore the usability and acceptability of HealthEir, a blended model with digital, print, and communication elements designed to support the delivery of brief health-promoting interventions in pharmacy practice. METHODS Usability tests using a think aloud protocol and set tasks (to assess usability) and semi-structured interviews (to assess acceptability) were conducted with fifteen patients and twelve pharmacists. Usability data were analysed deductively using Nielsen's five quality components of usability as a framework. Acceptability data were analysed using inductive thematic analysis. FINDINGS All participants found HealthEir straightforward to use and completed the required tasks without assistance. A small number of patient and pharmacist participants identified opportunity for improvement of the digital element. Acceptability was also high, with individual comments from participants identifying opportunity for improvements to HealthEir, and two patients identifying privacy or safety concerns. The majority of comments regarding acceptability reflected wider social and cultural challenges such as perceptions of the roles of pharmacists and pharmacies and the low priority of preventative health interventions. CONCLUSION HealthEir has been demonstrated to be a usable and acceptable support that has the potential to overcome barriers to delivery of brief interventions in pharmacies. Usability and acceptability testing identified minor changes that may further improve its design prior to piloting and implementation.
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18
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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19
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Fontaine G, Cossette S. Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling. Comput Inform Nurs 2023; 41:130-141. [PMID: 35796716 DOI: 10.1097/cin.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.
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Affiliation(s)
- Guillaume Fontaine
- Author Affiliations: Clinical Epidemiology Program, Ottawa Hospital Research Institute; and Faculty of Medicine, University of Ottawa, Ontario; and Research Centre, Université de Montréal Hospital Centre (Dr Fontaine); and Faculty of Nursing, Université de Montréal; and Montreal Heart Institute Research Center (Dr Cossette), Quebec, Canada
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20
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Sharma K, Ghosh A, Krishnan NC, Kathirvel S, Basu D, Kumar A, George BB. Digital screening and brief intervention for illicit drug misuse in college students: A mixed methods, pilot, cluster, randomized trial from India. Asian J Psychiatr 2023; 81:103432. [PMID: 36610207 DOI: 10.1016/j.ajp.2022.103432] [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: 09/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Adolescence and early adulthood are vulnerable periods for substance use-related disorders later in life. The use of internet-enabled interventions can be useful, especially in low-resource settings. AIMS To examine the feasibility, acceptability, and preliminary effectiveness of single-session digital screening and brief intervention (d-SBI) for illicit drug misuse in college students and explore barriers and facilitators of d-SBI. METHODS Design: Mixed-methods, pilot cluster randomized trial. SETTING Four conveniently selected colleges were randomized into intervention and control groups. PARTICIPANTS 219 students were screened, and 37 fulfilled eligibility. Twenty-four completed follow-ups. In-depth interviews were done with ten students. Intervention and Comparator: Following a digital screening, Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) based brief intervention was provided in the d-SBI group. The control group received brief education. MEASUREMENTS Acceptability was assessed by direct questions and usage statistics. ASSIST scores of groups were assessed at baseline and 3 months. Inductive coding of the interview transcript was done. RESULTS More than 50 % of participants found d-SBI user-friendly, appropriate, and useful. Eighty percent of users, who logged in, completed screening. Per-protocol analysis showed a reduction in cannabis-ASSIST score over 3 months. The mean ASSIST score for other drugs combined did not differ significantly between groups. The difference in risk transition (moderate to low) was not significant. Qualitative analysis revealed three overarching themes- recruitment, engagement, and behavior change. CONCLUSIONS Digital SBI for drug misuse is feasible among college students. d-SBI might be effective in reducing cannabis use.
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Affiliation(s)
- Kshitiz Sharma
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Abhishek Ghosh
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India.
| | | | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Debasish Basu
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
| | - Anil Kumar
- Department of Computer Science, Indian Institute of Technology (IIT), Ropar, India
| | - Blessy B George
- Drug De-Addiction & Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh, India
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21
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Roach A, Cullinan S, Shafran R, Heyman I, Bennett S. Implementing brief and low-intensity psychological interventions for children and young people with internalizing disorders: a rapid realist review. Br Med Bull 2023; 145:120-131. [PMID: 36715209 PMCID: PMC10075242 DOI: 10.1093/bmb/ldad001] [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: 09/23/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many children fail to receive the mental health treatments they need, despite strong evidence demonstrating efficacy of brief and low-intensity psychological interventions. This review identifies the barriers and facilitators to their implementation. SOURCES OF DATA PsycInfo, EMBASE and Medline were searched and a systematic approach to data extraction using Normalization Process Theory highlighted key mechanisms and contextual factors. AREAS OF AGREEMENT Ten interventions from 9 papers, including 371 young people, were included. Studies identified organizational demands, lack of implementation strategy and stigma as barriers to implementation, and clear training and plans for implementation as facilitators. AREAS OF CONTROVERSY No standardized implementation outcomes were used across papers so meta-analysis was not possible. GROWING POINTS Barriers and facilitators have been clearly identified across different settings. AREAS TIMELY FOR DEVELOPING RESEARCH Longitudinal studies can identify methods and processes for enhancing long-term implementation and considers ways to monitor and evaluate uptake into routine practice.
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Affiliation(s)
- Anna Roach
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Sophie Cullinan
- Institute of Education, UCL's Faculty of Education and Society, University College London, 20 Bedford Way, London WC1H 0AL, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Park JJ, King DL, Wilkinson-Meyers L, Rodda SN. The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services. Int J Ment Health Addict 2023:1-16. [PMID: 36714324 PMCID: PMC9869840 DOI: 10.1007/s11469-023-01010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines.
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Affiliation(s)
- Jennifer J. Park
- School of Population Health, University of Auckland, Private Bag 92019, 1142 Auckland, New Zealand
| | - Daniel L. King
- College of Education, Psychology & Social Work, Flinders University, GPO Box 2100, 5001 Adelaide, South Australia Australia
| | - Laura Wilkinson-Meyers
- School of Population Health, University of Auckland, Private Bag 92019, 1142 Auckland, New Zealand
| | - Simone N. Rodda
- Department of Psychology and Neuroscience, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627 Auckland, New Zealand
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman DI, Nielsen S. Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs. Drug Alcohol Rev 2023; 42:193-202. [PMID: 36169553 PMCID: PMC10947049 DOI: 10.1111/dar.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Amelia Berg
- Association of Participating Services UsersSelf Help Addiction Resource CentreMelbourneAustralia
| | | | - Michael Savic
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:50. [PMID: 35794580 PMCID: PMC9258127 DOI: 10.1186/s13011-022-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. Design A cross-sectional survey Setting Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. Participants A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants’ records were reviewed to assess the screening and management of AUD. Results In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). Conclusion While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.
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Schøler PN, Søndergaard J, Barfod S, Nielsen AS. Danish feasibility study of a new innovation for treating alcohol disorders in primary care: the 15-method. BMC PRIMARY CARE 2022; 23:34. [PMID: 35227207 PMCID: PMC8884098 DOI: 10.1186/s12875-022-01639-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022]
Abstract
Background The 15-method: a new brief intervention tool for alcohol problems in primary care has shown promising results in Sweden for mild to moderate alcohol use disorders. The present study evaluated the 15-method’s usability, organizational integration, and overall implementation feasibility in Danish general practice in preparation for a large-scale evaluation of the method’s effectiveness in identifying and treating alcohol problems in general practice. Methods Five general practices in the Central and Southern Region of Denmark participated: seven general practitioners (GPs), eight nurses. Participants received a half day of training in the 15-method. Testing of implementation strategies and overall applicability ran for 2 months. A focus group interview and two individual interviews with participating GPs along with five individual patient interviews concluded the study period. Results Results indicate that implementation of the 15-method is feasible in Danish general practice. The healthcare professionals and patients were positive about the method and its possibilities. The method was considered a new patient centered treatment offer and provided structure to a challenging topic. An interdisciplinary approach was much welcomed. Results indicate that the method is ready for large scale evaluation. Conclusions Implementation of the 15-method is considered feasible in Danish general practice and large-scale evaluation is currently being planned.
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Gorukanti AL, Kimminau KS, Tindle HA, Klein JD, Gorzkowski J, Kaseeska K, Ali R, Singh L, David SP, Halpern-Felsher B. Cross-sectional online survey of clinicians' knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use. BMJ Open 2022; 12:e059019. [PMID: 36414284 PMCID: PMC9685226 DOI: 10.1136/bmjopen-2021-059019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine adolescent healthcare clinicians' self-reported screening practices as well as their knowledge, attitudes, comfort level and challenges with screening and counselling adolescents and young adults (AYA) for cigarette, e-cigarette, alcohol, marijuana, hookah and blunt use. DESIGN A 2016 cross-sectional survey. SETTING Academic departments and community-based internal medicine, family medicine and paediatrics practices. PARTICIPANTS Adolescent healthcare clinicians (N=771) from 12 US medical schools and respondents to national surveys. Of the participants, 36% indicated male, 64% female, mean age was 44 years (SD=12.3); 12.3% of participants identified as Asian, 73.7% as white, 4.8% as black, 4.2% as Hispanic and 3.8% as other. PRIMARY AND SECONDARY OUTCOME MEASURES Survey items queried clinicians about knowledge, attitudes, comfort level, self-efficacy and challenges with screening and counselling AYA patients about marijuana, blunts, cigarettes, e-cigarettes, hookah and alcohol. RESULTS Participants were asked what percentage of their 10-17 years old patients they screened for substance use. The median number of physicians reported screening 100% of their patients for cigarette (1st, 3rd quartiles; 80, 100) and alcohol use (75, 100) and 99.5% for marijuana use (50,100); for e-cigarettes, participants reported screening half of their patients and 0.0% (0, 50), (0, 75)) reported screening for hookah and blunts, respectively. On average (median), clinicians estimated that 15.0% of all 10-17 years old patients smoked cigarettes, 10.0% used e-cigarettes, 20.0% used marijuana, 25.0% drank alcohol and 5.0% used hookah or blunts, respectively; yet they estimated lower than national rates of use of each product for their own patients. Clinicians reported greater comfort discussing cigarettes and alcohol with patients and less comfort discussing e-cigarettes, hookah, marijuana and blunts. CONCLUSIONS This study identified low rates of screening and counselling AYA patients for use of e-cigarettes, hookahs and blunts by adolescent healthcare clinicians and points to potential missed opportunities to improve prevention efforts.
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Affiliation(s)
- Anu L Gorukanti
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Kim S Kimminau
- Department of Family and Community Medicine, University of Missouri Columbia, Columbia, Missouri, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Julie Gorzkowski
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois, USA
| | - Kristen Kaseeska
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois, USA
| | - Raabiah Ali
- Healthcare Settings Program, Chicago Department of Public Health, Chicago, Illinois, USA
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Sean P David
- Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
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Lubman DI, Grigg J, Reynolds J, Hall K, Baker AL, Staiger PK, Tyler J, Volpe I, Stragalinos P, Harris A, Best D, Manning V. Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:1055-1064. [PMID: 36129698 PMCID: PMC9494267 DOI: 10.1001/jamapsychiatry.2022.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration ANZCTR Identifier: ACTRN12618000828224.
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Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - David Best
- Department of Criminology, University of Derby, Derby, United Kingdom
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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Monteiro MG, Pantani D, Pinsky I, Hernandes Rocha TA. The development of the Pan American Health Organization digital health specialist on alcohol use. Front Digit Health 2022; 4:948187. [PMID: 36386047 PMCID: PMC9643434 DOI: 10.3389/fdgth.2022.948187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction On 19 November 2021 the Pan American Health Organization (PAHO) developed and deployed the first-ever digital health worker dedicated to alcohol-related topics, named Pahola. This paper describes this developmental process and the first results of its uptake and interactions with the public. Methods PAHO secured a non-exclusive worldwide license with a technology company to use their Human OS ecosystem, which enables human-like interactions between digital people and users via an application. Google Digital flow ES was used to develop the conversations of Pahola on topics related to alcohol and health, screening of alcohol risk using the AUDIT and providing a quit/cut back plan to users, along with additional treatment services and resources in each country of the Americas. A communication campaign was also implemented from launching date until 31 December 2021. Results Pahola attracted good attention from the media, and potentially reached 1.6 million people, leading to 236,000 sessions on its landing page, mostly through mobile devices. The average time people effectively spent talking to Pahola was five minutes. Major dropouts were observed in different steps of the conversation flow. Discussion Pahola was quickly able to connect to a large worldwide population with reliable alcohol information. It could potentially increase the delivery of SBI and improve alcohol health literacy. However, its preliminary results pointed to much needed changes to its corpus and on its accessibility, which are being currently implemented.
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Affiliation(s)
- Maristela G. Monteiro
- Senior Advisor on Alcohol, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States,Correspondence: Maristela G. Monteiro
| | - Daniela Pantani
- International Consultant, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Ilana Pinsky
- International Consultant, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Thiago Augusto Hernandes Rocha
- Advisor on Public Health Data Analysis, Department of Health Analysis, Metrics and Evidence, Pan American Health Organization, Washington, DC, United States
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Lemp JM, Pengpid S, Buntup D, Bärnighausen TW, Geldsetzer P, Peltzer K, Rehm J, Sornpaisarn B, Probst C. Addressing alcohol use among blood pressure patients in Thai primary care: Lessons from a survey-based stakeholder consultation. Prev Med Rep 2022; 29:101954. [PMID: 36161118 PMCID: PMC9502666 DOI: 10.1016/j.pmedr.2022.101954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Alcohol use is a major risk factor for noncommunicable diseases in Thailand, and one of its pathways is high blood pressure. Given that brief intervention can effectively reduce hazardous alcohol consumption, this study aimed to investigate how hypertensive patients with concomitant alcohol use are identified and treated in Thai primary care settings and what this may mean for screening and lifestyle intervention strategies. In a cross-sectional, mixed-method design, we surveyed 91 participants from three different groups of Thai stakeholders: policy- and decisionmakers; healthcare practitioners; and patients diagnosed with hypertension. Data was collected between December 2020 and May 2021. Responses were analyzed descriptively and using open coding tools to identify current practices, barriers, facilitators, and implications for interventions. All stakeholder groups regarded alcohol use as an important driver of hypertension. While lifestyle interventions among hypertensive patients were perceived as beneficial, current lifestyle support was limited. Barriers included limited resources in primary healthcare facilities, lack of continuous monitoring or follow-up, missing tools or procedures for risk assessment and lifestyle intervention, and stigmatization of alcohol use. Our results suggest that although screening for lifestyle risk factors (including alcohol use) and lifestyle interventions are not yet sufficiently established, a wide range of stakeholders still recognize the potential of interventions targeted at hazardous alcohol use among hypertensive patients. Future interventions may establish standardized assessment tools, be tailored to high-risk groups, and include electronic or remote elements.
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Affiliation(s)
- Julia M. Lemp
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Doungjai Buntup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Till W. Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Corresponding author at: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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Freyer-Adam J, Krolo F, Tiede A, Goeze C, Sadewasser K, Spielmann M, Krause K, John U. Proactive automatised lifestyle intervention (PAL) in general hospital patients: study protocol of a single-group trial. BMJ Open 2022; 12:e065136. [PMID: 36123081 PMCID: PMC9486346 DOI: 10.1136/bmjopen-2022-065136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The co-occurrence of health risk behaviours (HRBs, ie, tobacco smoking, at-risk alcohol use, insufficient physical activity and unhealthy diet) increases the risks of cancer, other chronic diseases and mortality more than additively; and applies to more than half of adult general populations. However, preventive measures that target all four HRBs and that reach the majority of the target populations, particularly those persons most in need and hard to reach are scarce. Electronic interventions may help to efficiently address multiple HRBs in healthcare patients. The aim is to investigate the acceptance of a proactive and brief electronic multiple behaviour change intervention among general hospital patients with regard to reach, retention, equity in reach and retention, satisfaction and changes in behaviour change motivation, HRBs and health. METHODS AND ANALYSIS A pre-post intervention study with four time points is conducted at a general hospital in Germany. All patients, aged 18-64 years, admitted to participating wards of five medical departments (internal medicine A and B, general surgery, trauma surgery, ear, nose and throat medicine) are systematically approached and invited to participate. Based on behaviour change theory and individual HRB profile, 175 participants receive individualised and motivation-enhancing computer-generated feedback at months 0, 1 and 3. Intervention reach and retention are determined by the proportion of participants among eligible patients and of participants who continue participation, respectively. Equity in reach and retention are measured with regard to school education and other sociodemographics. To investigate satisfaction with the intervention and subsequent changes, a 6-month follow-up is conducted. Descriptive statistics, multivariate regressions and latent growth modelling are applied. ETHICS AND DISSEMINATION The local ethics commission and data safety appointee approved the study procedures. Results will be disseminated via publication in international scientific journals and presentations on scientific conferences. TRIAL REGISTRATION NUMBER NCT05365269.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Filipa Krolo
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Anika Tiede
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Christian Goeze
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Kornelia Sadewasser
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Marie Spielmann
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Kristian Krause
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
- Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Rosário F, Vasiljevic M, Pas L, Angus C, Ribeiro C, Fitzgerald N. Efficacy of a theory-driven program to implement alcohol screening and brief interventions in primary health-care: a cluster randomized controlled trial. Addiction 2022; 117:1609-1621. [PMID: 34935229 DOI: 10.1111/add.15782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Screening and brief interventions (SBI) in primary health-care practices (PHCP) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory-based intervention for PHCPs could significantly increase alcohol SBI delivery. DESIGN Two-arm, cluster-randomized controlled, parallel, 12-month follow-up, trial. SETTING PHCPs in Portugal. PARTICIPANTS Staff from 12 PHCPs (n = 222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention n = 8062; controls n = 58. INTERVENTION AND COMPARATOR PHCPs were randomized to receive a training and support program (n = 6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBIs following the principles of the Behavior Change Wheel/Theoretical Domains Framework approach, or to a waiting-list control (n = 6; 112 participants). Training was delivered over the first 12 weeks of the trial. MEASUREMENTS The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen-positive patient and the population-based BI rate (unit of analysis: patient list), and changes in health providers' perceptions of barriers to implementation and alcohol-related knowledge (unit of analysis: health provider). FINDINGS The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12-month follow-up (21.7% vs. 0.16%, intention-to-treat analysis, p = 0.003). Although no significant difference was found on the BI rate per screen-positive patient (intervention 85.7% vs. control 63.6%, p = 0.55, Bayes factor = 0.28), the intervention was effective in increasing the population-based BI rate (intervention 0.69% vs. control 0.02%, p = 0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol-related knowledge at 12-month follow-up than those in control practices. CONCLUSION A theory-based implementation program, which included training and support activities, significantly increased alcohol screening and population-based brief intervention rates in primary care.
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Affiliation(s)
- Frederico Rosário
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal.,Agrupamento de Centros de Saúde Dão Lafões, Viseu, Portugal
| | - Milica Vasiljevic
- Department of Psychology, Durham University, Durham, UK.,Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Niamh Fitzgerald
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, Scotland, UK
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Jankhotkaew J, Casswell S, Huckle T, Chaiyasong S, Phonsuk P. Barriers and Facilitators to the Implementation of Effective Alcohol Control Policies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116742. [PMID: 35682320 PMCID: PMC9180061 DOI: 10.3390/ijerph19116742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/01/2023]
Abstract
Implementation of effective alcohol control policies is a global priority. However, at the global and national levels, implementing effective policies is still challenging, as it requires commitment from multiple stakeholders. This review provides a synthesis of barriers and facilitators to implementing effective alcohol control policies. We conducted a scoping review from two main databases: Scopus and Web of Science, and the grey literature from the World Health Organization's website. We included any studies investigating barriers and facilitators to implementing four effective policies: Alcohol pricing and taxation, control of physical availability, alcohol marketing control, and drink-driving policy. Articles published between 2000 and 2021 were included. The search yielded 11,651 articles, which were reduced to 21 after the assessment of eligibility criteria. We found five main barriers: resource constraint; legal loopholes; lack of evidence to support policy implementation, particularly local evidence; low priority of policy implementation among responsible agencies; and insufficient skills of implementers. Facilitators, which were scarce, included establishing monitoring systems and local evidence to support policy implementation and early engagement of implementing agencies and communities. We recommend that national governments pay more attention to potential barriers and facilitators while designing alcohol control regulations and implementing effective policies.
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Affiliation(s)
- Jintana Jankhotkaew
- Social and Health Outcomes Research and Evaluation & Whariki Research Centre, Massey University, Victoria Street West, P.O. Box 6137, Auckland 1142, New Zealand; (S.C.); (T.H.)
- International Health Policy Program, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand;
- Correspondence:
| | - Sally Casswell
- Social and Health Outcomes Research and Evaluation & Whariki Research Centre, Massey University, Victoria Street West, P.O. Box 6137, Auckland 1142, New Zealand; (S.C.); (T.H.)
| | - Taisia Huckle
- Social and Health Outcomes Research and Evaluation & Whariki Research Centre, Massey University, Victoria Street West, P.O. Box 6137, Auckland 1142, New Zealand; (S.C.); (T.H.)
| | - Surasak Chaiyasong
- International Health Policy Program, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand;
- Alcohol and Health Promotion Policy Research Unit and Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kham Riang, Kantharawichai District, Maha Sarakham 44150, Thailand
| | - Payao Phonsuk
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Ratchawithi Road, Ratchathewi District, Bangkok 10400, Thailand;
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Suryavanshi N, Dhumal G, Cox SR, Sangle S, DeLuca A, Santre M, Gupta A, Chander G, Hutton H. Acceptability, Adaptability, and Feasibility of a Novel Computer-Based Virtual Counselor-Delivered Alcohol Intervention: Focus Group and In-depth Interview Study Among Adults With HIV or Tuberculosis in Indian Clinical Settings. JMIR Form Res 2022; 6:e35835. [PMID: 35622406 PMCID: PMC9187965 DOI: 10.2196/35835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB. OBJECTIVE We assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India. METHODS We conducted 10 in-depth interviews with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis. RESULTS The majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program's effectiveness by providing more flexible interaction. HCP focus group participants noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators, and activities to substitute for drinking alcohol were suggested by all focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff. CONCLUSIONS With cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor-delivered alcohol intervention is acceptable and appears feasible to implement, particularly if coupled with person-delivered counseling.
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Affiliation(s)
- Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trials Unit, Pune, India
| | - Gauri Dhumal
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Trials Unit, Pune, India
| | - Samyra R Cox
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Shashikala Sangle
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, India
| | - Andrea DeLuca
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Manjeet Santre
- Department of Psychiatry, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, India
| | - Amita Gupta
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Geetanjali Chander
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Heidi Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Demonstration of Caring and Motivational Interviewing in Online Simulation: A Cross-Sectional Observational Study. Nurse Educ Pract 2022; 63:103370. [DOI: 10.1016/j.nepr.2022.103370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
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McGovern R, Homer T, Kaner E, Smart D, Ternent L. Preferences for Delivering Brief Alcohol Intervention to Risky Drinking Parents in Children's Social Care: A Discrete Choice Experiment. Alcohol Alcohol 2022; 57:615-621. [PMID: 35443044 PMCID: PMC9465525 DOI: 10.1093/alcalc/agac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Many parents in contact with children's social care services misuse alcohol however do not meet the threshold for specialist alcohol treatment, and typically do not receive appropriate support for their needs. Brief alcohol interventions have been found to be effective in healthcare settings, however, it is unknown whether the brief intervention structure delivered within health settings would transfer well into children's social care. This paper aims to examine the characteristics of brief intervention for alcohol misusing parents which social care practitioners consider to be important and acceptable to implement in this sector. METHODS We assessed preferences for, and acceptability of, brief alcohol intervention with parents in contact with children's social care using a discrete choice experiment. We recruited 205 children's social care practitioners from London and the North East of England. Data were analysed using mixed logit which accounted for repeated responses. FINDINGS Six attributes showed statistically significant coefficients, suggesting that a brief intervention with these attributes would encourage implementation. These were: level of alcohol-related risk targeted; intervention recipient; timing of intervention; duration of sessions; number of sessions and intervention structure. The attribute of most importance identified based on the attribute with the largest coefficient in the conditional logit model was risk level. CONCLUSIONS Brief alcohol interventions delivered to parents in social care should focus on the impact upon children and the wider family, they should be a flexible part of on-going casework and should be more intensive and less structured.
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Affiliation(s)
- R McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - T Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - D Smart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - L Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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Lin Y, Sharma B, Thompson HM, Boley R, Perticone K, Chhabra N, Afshar M, Karnik NS. External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients. Addiction 2022; 117:925-933. [PMID: 34729829 PMCID: PMC9296269 DOI: 10.1111/add.15730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/13/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Unhealthy alcohol use (UAU) is one of the leading causes of global morbidity. A machine learning approach to alcohol screening could accelerate best practices when integrated into electronic health record (EHR) systems. This study aimed to validate externally a natural language processing (NLP) classifier developed at an independent medical center. DESIGN Retrospective cohort study. SETTING The site for validation was a midwestern United States tertiary-care, urban medical center that has an inpatient structured universal screening model for unhealthy substance use and an active addiction consult service. PARTICIPANTS/CASES Unplanned admissions of adult patients between October 23, 2017 and December 31, 2019, with EHR documentation of manual alcohol screening were included in the cohort (n = 57 605). MEASUREMENTS The Alcohol Use Disorders Identification Test (AUDIT) served as the reference standard. AUDIT scores ≥5 for females and ≥8 for males served as cases for UAU. To examine error in manual screening or under-reporting, a post hoc error analysis was conducted, reviewing discordance between the NLP classifier and AUDIT-derived reference. All clinical notes excluding the manual screening and AUDIT documentation from the EHR were included in the NLP analysis. FINDINGS Using clinical notes from the first 24 hours of each encounter, the NLP classifier demonstrated an area under the receiver operating characteristic curve (AUCROC) and precision-recall area under the curve (PRAUC) of 0.91 (95% CI = 0.89-0.92) and 0.56 (95% CI = 0.53-0.60), respectively. At the optimal cut point of 0.5, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.66 (95% CI = 0.62-0.69), 0.98 (95% CI = 0.98-0.98), 0.35 (95% CI = 0.33-0.38), and 1.0 (95% CI = 1.0-1.0), respectively. CONCLUSIONS External validation of a publicly available alcohol misuse classifier demonstrates adequate sensitivity and specificity for routine clinical use as an automated screening tool for identifying at-risk patients.
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Affiliation(s)
- Yiqi Lin
- Rush Medical CollegeRush UniversityChicagoILUSA
| | - Brihat Sharma
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | - Hale M. Thompson
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | - Randy Boley
- Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
| | | | - Neeraj Chhabra
- Department of Emergency Medicine, Rush Medical CollegeRush UniversityChicagoILUSA,Department of Emergency MedicineJohn. H. Stroger, Jr. Hospital of Cook CountyChicagoILUSA
| | - Majid Afshar
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Niranjan S. Karnik
- Rush Medical CollegeRush UniversityChicagoILUSA,Department of Psychiatry and Behavioral SciencesRush Medical College, Rush UniversityChicagoILUSA
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Barriers and Facilitators to Screening for Cognitive Impairment in Australian Rural Health Services: A Pilot Study. Geriatrics (Basel) 2022; 7:geriatrics7020035. [PMID: 35447838 PMCID: PMC9029066 DOI: 10.3390/geriatrics7020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023] Open
Abstract
Australian National standards recommend routine screening for all adults over 65 years by health organisations that provide care for patients with cognitive impairment. Despite this, screening rates are low and, when implemented, screening is often not done well. This qualitative pilot study investigates barriers and facilitators to cognitive screening for older people in rural and regional Victoria, Australia. Focus groups and interviews were undertaken with staff across two health services. Data were analysed via thematic analysis and contextualized within the i-PARIHS framework. Key facilitators of screening included legislation, staff buy-in, clinical experience, appropriate training, and interorganisational relationships. Collaborative implementation processes, time, and workloads were considerations in a recently accredited tertiary care setting. Lack of specialist services, familiarity with patients, and infrastructural issues may be barriers exacerbated in rural settings. In lieu of rural specialist services, interorganisational relationships should be leveraged to facilitate referring ‘outwards’ rather than ‘upwards’.
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Karlsson N, Skagerström J, O'Donnell A, Abidi L, Thomas K, Nilsen P, Lid TG. Public perceptions of how alcohol consumption is dealt with in Swedish and Norwegian health care. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:243-255. [PMID: 35310609 PMCID: PMC8899254 DOI: 10.1177/1455072520985981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Aims: The aims of this study were to evaluate and compare popular beliefs and attitudes regarding alcohol conversations in healthcare in Sweden and Norway; and to explore which factors were associated with different levels of support for alcohol-prevention work in the two countries. Methods: Population-based cross-sectional surveys were conducted in Sweden (n = 3000) and Norway (n = 1208). Logistic regression was used to identify the characteristics of participants who were supportive of routine alcohol screening and brief intervention delivery. Results: A higher proportion of Swedish respondents agreed to a large extent that healthcare professionals should routinely ask about alcohol consumption. In addition, a higher proportion of Swedish respondents compared to respondents from Norway agreed that healthcare providers should only ask about patient’s alcohol consumption if this was related to specific symptoms. There were similar correlates of being supportive of routine alcohol screening and brief intervention delivery in both countries. Support was lower in both countries amongst moderate and risky drinkers, and among single adults or those on parental leave, but higher amongst older individuals. Having had an alcohol conversation in healthcare increased the level of support for alcohol prevention in routine healthcare among risky drinkers. Conclusions: There is a high level of support for preventative alcohol conversations in routine healthcare in Norway and Sweden, although there was a lower proportion of respondents who were positive to alcohol prevention in routine healthcare in Norway compared to Sweden. Experiencing alcohol conversation may positively affect risky drinkers’ attitudes towards and support for alcohol prevention. Thus, more frequent alcohol conversations in routine healthcare may also result in increased level of support for alcohol prevention among risky drinkers.
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Affiliation(s)
| | - Janna Skagerström
- Linköping University, Sweden; and Research and Development Unit in Region Östergötland, Linköping, Sweden
| | | | | | | | | | - Torgeir Gilje Lid
- Stavanger University Hospital, Norway; and University of Stavanger, Norway
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Dutey-Magni P, Brown J, Holmes J, Sinclair J. Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT. Addiction 2022; 117:580-589. [PMID: 34374144 DOI: 10.1111/add.15662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. DESIGN Cross-sectional diagnostic study based on a nationally-representative survey. SETTINGS Community dwelling households in England. PARTICIPANTS A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. MEASUREMENTS Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. FINDINGS EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). CONCLUSIONS A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
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Affiliation(s)
- Peter Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jamie Brown
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
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Meade O, O'Brien M, Mc Sharry J, Lawless A, Coughlan S, Hart J, Hayes C, Keyworth C, Lavoie KL, Murphy AW, Murphy P, Noone C, O'Reilly O, Byrne M. Enhancing the implementation of the Making Every Contact Count brief behavioural intervention programme in Ireland: protocol for the Making MECC Work research programme. HRB Open Res 2022; 5:6. [PMID: 35224443 PMCID: PMC8847722 DOI: 10.12688/hrbopenres.13481.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Brief behavioural interventions offered by healthcare professionals to target health behavioural risk factors (e.g. physical activity, diet, smoking and drug and alcohol use) can positively impact patient health outcomes. The Irish Health Service Executive (HSE) Making Every Contact Count (MECC) Programme supports healthcare professionals to offer patients brief opportunistic behavioural interventions during routine consultations. The potential for MECC to impact public health depends on its uptake and implementation. Aim: This protocol outlines the ‘Making MECC Work’ research programme, a HSE/Health Behaviour Change Research Group collaboration to develop an implementation strategy to optimise uptake of MECC in Ireland. The programme will answer three research questions: (1) What determines delivery of MECC brief interventions by healthcare professionals at individual and organisational levels? (2) What are patient attitudes towards, and experiences of, receiving MECC interventions from healthcare professionals? (3) What evidence-informed implementation strategy options can be consensually developed with key stakeholders to optimise MECC implementation? Methods: In Work Package 1, we will examine determinants of MECC delivery by healthcare professionals using a multi-methods approach, including: (WP1.1) a national survey of healthcare professionals who have participated in MECC eLearning training and (WP1.2) a qualitative interview study with relevant healthcare professionals and HSE staff. In Work Package 2, we will examine patient attitudes towards, and experiences of, MECC using qualitative interviews. Work Package 3 will combine findings from Work Packages 1 and 2 using the Behaviour Change Wheel to identify and develop testable implementation strategy options (WP 3.1). Strategies will be refined and prioritised using a key stakeholder consensus process to develop a collaborative implementation blueprint to optimise and scale-up MECC (WP3.2). Discussion: Research programme outputs are expected to positively support the integration of MECC brief behaviour change interventions into the Irish healthcare system and inform the scale-up of behaviour change interventions internationally.
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Affiliation(s)
- Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Maria O'Brien
- National Heart Programme, Integrated Care Programme for Chronic Disease, Clinical Design and Innovation, Office of the Chief Clinical Officer, Health Services Executive, Áras Sláinte, Wilton Road, Cork, T12 XRR0, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Agatha Lawless
- Health & Wellbeing, Strategy and Research, Healthcare Strategy, c/o Health Promotion and Improvement Office, Health Service Executive, Waterford, X91 T256, Ireland
| | - Sandra Coughlan
- Strategic Planning and Transformation, Health Service Executive, Cork, T12 WP62, Ireland
| | - Jo Hart
- School of Medical Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Catherine Hayes
- Public Health and Primary Care, School of Medicine, Trinity College Dubin, Dublin, D02 R590, Ireland
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Kim L Lavoie
- Montréal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital Sacré-Cœur de Montréal, Montréal, Quebec, QC H4J 1C5, Canada
- Department of Psychology, University of Quebec at Montréal, Montréal, Quebec, QC H2L 2C4, Canada
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Patrick Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Chris Noone
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Orlaith O'Reilly
- Health and Wellbeing Division, HSE South East, Public Health Department, Health Service Executive, Kilkenny, Ireland
| | | | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
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Solovei A, Jané-Llopis E, Mercken L, Bustamante I, Kokole D, Mejía-Trujillo J, Medina Aguilar PS, Natera Rey G, O'Donnell A, Piazza M, Schmidt CS, Anderson P, de Vries H. Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:224-236. [PMID: 35032246 PMCID: PMC8760585 DOI: 10.1007/s11121-021-01329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/25/2022]
Abstract
Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Univ. Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Department of Health Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Tan HT, Lui YS, Peh LH, Winslow RM, Guo S. Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting. Subst Abuse 2022; 16:11782218211065755. [PMID: 35035219 PMCID: PMC8753239 DOI: 10.1177/11782218211065755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards. METHODS A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources. RESULTS About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%). CONCLUSION/DISCUSSION Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. SCIENTIFIC SIGNIFICANCE The prompt identification and treatment of patients with alcohol problems are contingent on the workers' attitudes towards them. This study's results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.
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Affiliation(s)
- Ho Teck Tan
- Department of Psychological Medicine,
National University Hospital, Singapore
| | - Yit Shiang Lui
- Department of Psychological Medicine,
National University Health System, Singapore
| | - Lai Huat Peh
- Department of Psychological Medicine,
Changi General Hospital, Singapore
| | | | - Song Guo
- National Addictions Management Service,
Institute of Mental Health, Singapore
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Solovei A, Manthey J, Anderson P, Mercken L, Jané Llopis E, Natera Rey G, Pérez Gómez A, Mejía Trujillo J, Bustamante I, Piazza M, Pérez de León A, Arroyo M, de Vries H, Rehm J, Evers S. Costs of an Alcohol Measurement Intervention in Three Latin American Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:700. [PMID: 35055522 PMCID: PMC8776036 DOI: 10.3390/ijerph19020700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, Open University Postbus 2960, 6401DL Heerlen, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- ESADE Business School, University Ramon Llull, Av. de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Augusto Pérez Gómez
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Juliana Mejía Trujillo
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Alejandra Pérez de León
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, b. 2, 119992 Moscow, Russia
| | - Silvia Evers
- Department of Health Services Research CAPHRI Care, Public Health Research Institute, Maastricht University, POB 616, 6200MD Maastricht, The Netherlands;
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Mushi D, Francis JM, Moshiro C, Hanlon C, Teferra S. Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review. Front Psychiatry 2022; 13:822791. [PMID: 35370845 PMCID: PMC8964495 DOI: 10.3389/fpsyt.2022.822791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa. Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap. Integrating services for mental, neurological, and substance use disorders in general health care settings is among the recommended strategies to narrow this treatment gap. This scoping review aimed to map the available evidence on integration of AUD interventions in general health care settings in sub-Saharan Africa. METHODS We searched four databases (PubMed, PsycINFO, CINAHL, and Africa Wide Information) for publications up to December 2020. The search strategy focused on terms for alcohol use, alcohol interventions, and sub-Saharan African countries. Studies that reported AUD interventions in general health care settings in sub-Saharan Africa were eligible for inclusion. Over 3,817 potentially eligible articles were identified. After the removal of duplicates and screening of abstracts, 56 articles were included for full article review. Of these, 24 papers reporting on 22 studies were eligible and included in a narrative review. RESULTS Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities, and 2 (8%) studies reported on AUD interventions integrated into general health care settings. CONCLUSIONS This review shows that there is limited evidence on the integration of AUD interventions in health care settings in sub-Saharan Africa. There is an urgent need for studies that report systematically on the development, adaptation, implementation, and evaluation of integrated AUD interventions in health care settings in sub-Saharan Africa.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, Witwatersrand University, Johannesburg, South Africa.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Service and Population Research Department and WHO Collaborating Centre for Mental Health and Training, Institute of Psychiatry, Psychology, and Neuroscience, King's College University, London, United Kingdom
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Farhoudian A, Razaghi E, Hooshyari Z, Noroozi A, Pilevari A, Mokri A, Mohammadi MR, Malekinejad M. Barriers and Facilitators to Substance Use Disorder Treatment: An Overview of Systematic Reviews. Subst Abuse 2022; 16:11782218221118462. [PMID: 36062252 PMCID: PMC9434658 DOI: 10.1177/11782218221118462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
objective: This investigation explored the barriers and facilitators to substance use
disorder (SUD) treatment in the integrated paradigm. methods: A search technique for barriers and facilitators of SUD treatment was applied
to the PubMed and Web of Science databases to identify relevant systematic
reviews. The eligibility criteria included systematic review (SR) or SR plus
meta-analysis (MA) articles published before the end of 2021, human
research, and the English language. Each of the 12 relevant review articles
met the inclusion criteria. AMSTAR was utilised to evaluate the
methodological quality of the systematic reviews. results: Two authors analysed 12 SR/SR-MA articles to identify barriers or
facilitators of SUD treatment. The cumulative summary results of these 12
evaluations revealed that barriers and facilitators may be classified into 3
levels: individual, social and structural. By analysing these review papers,
37 structural barriers, 21 individual barriers and 19 social barriers were
uncovered, along with 15 structural facilitators, 9 social facilitators and
3 individual facilitators. conclusions: The majority of barriers indicated in the review articles included in this
analysis are structural, as are the majority of facilitators. Consequently,
the design of macro models for the treatment of substance use disorders may
yield various outcomes and potentially affect society and individual
levels.
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Affiliation(s)
- Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
| | - Azarakhsh Mokri
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Potthoff S, O'Donnell AJ, Karlsen AT, Brendryen H, Lid TG. Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention. FRONTIERS IN HEALTH SERVICES 2022; 2:940383. [PMID: 36925895 PMCID: PMC10012791 DOI: 10.3389/frhs.2022.940383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Introduction Alcohol consumption is a leading global risk factor for ill-health and premature death. Alcohol screening and brief interventions (SBI) delivered in primary care is effective at reducing alcohol consumption, but routine implementation remains problematic. Screening all patients for excessive drinking (universal screening) is resource-intensive and may be at odds with general practitioners' (GPs') perceived professional role. This study aimed to develop a tailored, theory-based training intervention to strengthen GPs' ability to address alcohol and to manage alcohol-related health problems through a pragmatic approach based on clinical relevance. Methods A qualitative study design involving focus group interviews and a structured questionnaire for free text replies with GPs in Norway. Behavioral analysis assessed factors influencing delivery of SBI according to the 'capability, opportunity, motivation and behavior' (COM-B) model to inform intervention development using the Behavior Change Wheel. Qualitative data were analyzed using framework analysis and an iterative approach was adopted to develop the training. Results A purposive sample of GPs attended the focus groups (n = 25) and completed the questionnaire (n = 55). Four areas required additional support including: understanding the link between alcohol use and health problems; opening up the conversation on alcohol use; addressing alcohol and dealing with obstacles; and following-up and maintaining change. Findings informed the development of a four-session interactive training intervention and a digital intervention for providing support for patients between consultations to address the identified needs. Conclusion This work highlights the value of pragmatic, relevance-based clinical strategies, as opposed to universal screening approaches to addressing alcohol in primary care. A pragmatic approach is more in line with GPs existing sclinical skill set and holds the potential to improve widespread uptake and implementation of SBI in routine primary care.
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Affiliation(s)
- Sebastian Potthoff
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Amy Jane O'Donnell
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Håvar Brendryen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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McNeely J, Mazumdar M, Appleton N, Bunting AM, Polyn A, Floyd S, Sharma A, Shelley D, Cleland CM. Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT). Subst Abus 2022; 43:564-572. [PMID: 34586976 PMCID: PMC9968463 DOI: 10.1080/08897077.2021.1975868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda M. Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonia Polyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Floyd
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Akarsh Sharma
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University Global School of Public Health
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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49
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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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McCaul ME, Hutton HE, Cropsey KL, Crane HM, Lesko CR, Chander G, Mugavero MJ, Kitahata MM, Lau B, Saag MS. Decreased Alcohol Consumption in an Implementation Study of Computerized Brief Intervention among HIV Patients in Clinical Care. AIDS Behav 2021; 25:4074-4084. [PMID: 33993353 PMCID: PMC8594281 DOI: 10.1007/s10461-021-03295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/28/2022]
Abstract
This prospective, nonrandomized implementation study evaluated a computerized brief intervention (CBI) for persons with HIV (PWH) and heavy/hazardous alcohol use. CBI was integrated into two HIV primary care clinics. Eligible patients were engaged in care, ≥ 18 years old, English speaking, endorsed heavy/hazardous alcohol use on the Alcohol Use Disorders Identification Test-C (AUDIT-C). Two 20-min computerized sessions using cognitive behavioral techniques were delivered by a 3-D avatar on touch screen tablets. Of 816 eligible AUDIT-C scores, 537 (66%) resulted in CBI invitation, 226 (42%) of invited patients enrolled, and 176 (78%) of enrolled patients watched at least one session. CBI enrollment was associated with a significant average reduction of 9.1 drinks/week (95% CI - 14.5, - 3.6) 4-12 months post-enrollment. Among those who participated in one or both sessions, average reduction in drinks/week was 11.7 drinks/week (95% CI - 18.8, - 4.6). There was corresponding improvement in AUDIT-C scores. Overall patients reported high levels of intervention satisfaction, particularly among older and Black patients. These promising results point to a practical intervention for alcohol reduction in this vulnerable patient population with elevated rates of heavy/hazardous drinking. Future research should examine strategies to increase initial engagement, strengthen intervention effects to increase the number of patients who achieve non-hazardous drinking, and examine the duration of therapeutic effects.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115, Baltimore, MD, 21205, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115, Baltimore, MD, 21205, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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