Efficacy of Brief Intervention for Drug Misuse in Primary Care: A Systematic Review and Meta-Analysis

Abstract

Background: Many primary care facilities have dedicated significant resources to drug misuse screening and brief intervention (BI). However, the efficacy of BI for drug misuse in primary care has not been substantiated, revealing many non-significant findings. Thus, we aimed to determine the efficacy of BI for drug misuse, length of effects, and benefits among primary care subpopulations. Methods: We searched CENTRAL, EMBASE, MEDLINE, PsycINFO, and reference lists up to January 13, 2021. The population were patients receiving primary care-delivered BI for drug misuse compared with usual care. Primary outcomes were drug use frequency (days used) and severity on validated scales at 4-8 months. Analyses were conducted using random-effects models. This study was registered in PROSPERO (CRD42020157733). Results: We identified 27 studies and analyzed 20 (7471 patients) at three follow-up timepoints for frequency and severity. There was insufficient evidence to support the efficacy of BI for drug misuse in general primary care for use frequency (SMD = -0·07, 95% CI = -0·17, 0·02, p = 0·12, I2 = 37%, high certainty of evidence) and severity (SMD = -0·27, 95% CI = -0·78, 0·24, p = 0·30, I2= 98%, low certainty of evidence). However, subgroup analyses uncovered significant effects for frequency (interaction p = 0·004) with insufficient evidence for hospital/community primary care (SMD = 0·07, 95% CI = -0·03, 0·18, p = 0·08), but significant small effects among emergency department (SMD = -0·15, 95% CI = -0·25, -0·04, p < 0·01) and specialty primary care populations (SMD = -0·19, 95% CI = -0·36, -0·02, p < 0·05).Interpretation: BI for drug misuse is not indicated in general primary care. Department heads could consider continuing BI, noting the small positive effects and confidence intervals found only in emergency and specialty clinics. Funding : Japan Society for the Promotion of Science (P19110 and 19F19110). Declaration of Interest: