Brief Interventions In Primary Care Research Articles

A Brief Intervention in Primary Care to Improve Parents’ Discipline Practices and Reach Other Caregivers

Parents (N = 599) of 6-month-old to 10-year-old children were given a handbook intervention that educates about healthy discipline in a pediatric clinic serving low-income families in Nashville, Tennessee. A research assistant spent approximately 1 minute introducing the intervention. A total of 440 parents (73.4%) responded to a follow-up survey 2 to 4 months later. Most parents (88%) who completed the follow-up survey had read at least part of the handbook. Of parents who received the handbook, 63% reported that the handbook helped them discipline their children. Half of parents reported specific changes they made because of the handbook. The most frequently reported changes were more talking/explaining/communicating (25%), more redirecting (7.8%), more patience/listening (6.0%), less anger/yelling (10.8%), and less spanking (7.5%). 42% of parents reported that they shared the handbook with other caregivers, friends, relatives, and children. A brief clinic intervention improves parents’ discipline practices and reaches other caregivers.

A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial

BackgroundGiven significant risks associated with long-term prescription opioid use, there is a need for non-pharmacological interventions for treating chronic pain. Activating patients to manage chronic pain has the potential to improve health outcomes. The ACTIVATE study was designed to evaluate the effectiveness of a 4-session patient activation intervention in primary care for patients on long-term opioid therapy.MethodsThe two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015—August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months.ResultsAt 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18–0.87); higher overall health (OR = 3.14, 95%CI 1.64–6.01); greater use of the patient portal’s health/wellness resources (OR = 2.50, 95%CI 1.42–4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29–5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61–4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29–3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27–2.98).ConclusionThis trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system.Trial RegistrationThe study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).

Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysis.

Brief interventions (BIs) are effective for reducing harmful alcohol consumption, but their use in primary care is less frequent than clinically indicated. The REducing AlCohol- related Harm (REACH) project aimed to increase the delivery of BIs in primary care. To assess the effectiveness of the REACH programme in increasing alcohol BIs in general practice and explore the implementation factors that improve or reduce uptake by clinicians. This article reports on a sequential, explanatory mixed-methods study of the implementation of the REACH project in six general practice clinics serving low-income communities in Melbourne, Australia. Time-series analyses were conducted using routinely collected patient records and semi-structured interviews, guided by the consolidated framework for implementation research. The six intervention sites significantly increased their rate of recorded alcohol status (56.7% to 60.4%), whereas there was no significant change in the non-intervention practices (344 sites, 55.2% to 56.4%). REACH resources were seen as useful and acceptable by clinicians and staff. National policies that support the involvement of primary care in alcohol harm reduction helped promote ongoing intervention sustainability.

A blended model to support brief interventions in primary care: A qualitative study of usability and acceptability of HealthEir in community pharmacy.

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. 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. 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. 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. 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.

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

ObjectivesTo evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).DesignA population-based observational...

Effectiveness of brief interventions in primary care for cannabis users aged from 12 to 25 years old: a systematic review.

The aim of this systematic review was to assess the effectiveness of brief interventions realized in primary care in reducing cannabis use for adolescents and emerging adults. PubMed, CINAHL, Embase, PsycInfo, and Central (Cochrane Library) were searched until December 2020. Randomized controlled trials conducted in primary care, concerning in-person brief interventions for non-medical cannabis users aged from 12 to 25 years old were eligible for inclusion. Brief interventions had to last 30 min or less. Patients with comorbid mental health disorder or very specific populations were not included. One thousand eighty hundred and fifty-five studies were identified through database searching; only 8 studies involving 2,199 patients were included for qualitative synthesis after double reading and data extraction. Randomized controlled trials selected were heterogeneous regarding screening tools, initial levels of cannabis use and cannabis outcomes measures. Brief interventions were all based on motivational interviewing techniques or personalized feedback. Seven studies consisted in a single session of brief intervention. Six studies involved also other substance users. No significant reduction of cannabis use after brief intervention was found for most studies, especially in the long term. A trend of decreased cannabis consequences, such as negative psychosocial repercussions, perception of cannabis use by peers, or driving under the influence of cannabis, was reported. The current state of knowledge does not allow us to say that the brief intervention is effective in reducing cannabis use among adolescents in primary care. We found a mild positive effect on cannabis consequences after brief intervention. Mixed qualitative and quantitative studies are need to better evaluate the impact of brief intervention and his faisability. PROSPERO (International Prospective Register of Systematic Reviews): n° CRD42016033080.

Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care

This study analyzed the marginal service and program costs, and conducted a cost-effectiveness analysis (CEA) of two models of implementation of adolescent substance screening, brief intervention, and referral to treatment (SBIRT). SBIRT was implemented at seven clinics in a multisite, cluster-randomized trial, through a Specialist model (behavioral health counselor-delivered brief intervention), and a Generalist model (primary care provider-delivered brief intervention). The CEA calculated marginal costs using an activity-based costing methodology for direct SBIRT services, and effectiveness was measured by the proportion of brief interventions delivered among patients who screened positive for alcohol, tobacco, or other drugs. Site-level program costs comprised start-up and maintenance (training and technical assistance). Costs were estimated in 2017 U.S. dollars. The marginal cost of SBIRT per patient with a positive screen for brief intervention was $6.72 in the Specialist model and $6.05 in the Generalist model. Implementation effectiveness was 7.2% (SE = 2.9%) in the Specialist model and 37.7% (SE = 5.6%) in the Generalist model. The program costs to provide SBIRT for 1 year per site were $13,548 for the Specialist site and $12,081 for the Generalist. The Generalist model was more effective in implementing brief intervention and less expensive than the Specialist model. Results were robust to sensitivity analysis. Brief intervention delivered by primary care providers rather than by handoff to a behavioral health counselor may ensure greater penetration and a lower cost of these services in primary care settings.

Delivering brief physical activity interventions in primary care: a systematic review.

BackgroundPhysical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown.AimTo examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity.Design and settingA mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results.MethodCINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model.ResultsAfter screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%–100% and 0.6%–100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers — including a lack of time and training/guidelines — remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients’ receptivity to advice.ConclusionPA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals’ confidence in their delivery.

Patient and clinician perspectives of factors that influence the delivery of alcohol brief interventions in Australian primary care: a qualitative descriptive study.

Brief interventions (BIs) delivered in primary care can reduce harmful alcohol consumption. Yet, clinicians do not routinely offer BIs to reduce harmful alcohol use. We explored the perspectives of clinicians and patients about the use of alcohol BIs during consultations in Australian primary care. Semi-structured interviews and focus groups (face-to-face and virtual) were undertaken with 34 general practitioners, eight practice nurses and 17 patients. Field notes were made from audio-recordings and themes were identified using a descriptive qualitative approach with the field notes as the point of data analysis. Participants identified barriers within the consultation, practice setting and wider healthcare system plus across the community which reduce the delivery of BIs in primary care including: Australian drinking norms; inconsistent public health messaging around alcohol harm; primary care not recognized as a place to go for help; community stigma towards alcohol use; practice team culture towards preventive health, including systems for recording alcohol histories; limitations of clinical software and current patient resources. Multiple layers of the healthcare system influence the use of BIs in primary care. Identified facilitators for embedding BIs in primary care included: (i) raising community and clinician awareness of the health harms of alcohol, (ii) reinforcing a primary care culture that promotes prevention and, (iii) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Alcohol BIs in primary care could be further supported by community public health messages about alcohol use.

Brief intervention of low carbohydrate dietary advice: clinic results and a review of the literature.

The purpose of the review is to assess the efficacy of a brief intervention of low carbohydrate dietary advice for weight loss in patients with a raised body mass index (BMI) (>25 kg/m2) during routine patient appointments in primary care. Brief interventions in primary care have been shown to be a valuable tool in supporting patients to make lifestyle changes. Low carbohydrate diets have been successful in helping patients lose weight.The authors carried out a retrospective observational study based on the electronic records from a single general practitioner surgery with 7,500 patients in Essex, UK. Low carbohydrate dietary advice was given opportunistically to patients with a raised BMI, over an 18 month period, with advice and weights recorded. In total, 774 patients were given low carbohydrate dietary advice. Overall, 1103 kg of weight was lost by 339 patients, there was a median weight loss of 2.5 kg (interquartile range 0.0-6.0 kg) and a mean weight loss of 3.3 kg. There is no published literature available assessing the efficacy of brief interventions of low carbohydrate dietary advice. Our clinic results indicate that this may be an effective weight loss tool in primary care.

Using Human-Centred Design to Develop Innovative Approaches to Improve Delivery of Brief Interventions in Primary Care: The HealthEir Project

IntroductionA priority action of the Healthy Ireland implementation plan is the Making Every Contact Count initiative (MECC) that aims to leverage the 30 million annual contacts with the healthcare system by asking every health worker to deliver brief interventions [1]. Benefits of brief interventions are well established, but GPs and pharmacists report challenges implementing them in practice including limited training, time, and poor fit with existing practices [2].AimThis government-funded Sláintecare project aimed to develop a novel method for brief interventions in pharmacy/GP settings using human-centred design.MethodsUser research was carried out with twelve users, including patients (3), GPs (4), and pharmacists (5) to identify their needs and priorities. Participants were recruited via email using a purposive sampling approach and completed semi-structured interviews with a design researcher. All participants invited agreed to participate. Next, a series of design sprints were completed with the research team. Design sprints allowed the team to integrate insights from user research with findings from a literature review/secondary research to understand pain points, identify stakeholder and user goals, and develop a list of initial design specifications. This list was used to develop and iterate a series of prototype solutions. Prototype service blueprints and wireframes (simple, two-dimensional schematic illustrations of the digital interface) were developed and tested with users before final versions were agreed.ResultsFindings from the interviews and literature review indicated (1) the main barrier to adoption was time, (2) patients and pharmacists were very positive about brief interventions with GPs more hesitant, (3) an approach blending technology with a consultation was preferred, and (4) having a specific list of local supports was important. Prototyping and evaluation processes identified that a simple interface with a clear indication of progress were preferred.A blended intervention combining a tablet-based digital tool and structured interaction was developed. The interface was designed to maximise use of patient and healthcare professional time, and mapped to the 5As approach (which is underpinned by principles of motivational interviewing, shared-decision making, and readiness to change frameworks). The HealthEir digital tool enables patients to self-complete the Ask, Advise, and Assess phases of a brief intervention using a tablet device while waiting to see their pharmacist/GP. The pharmacist or GP then review the patient’s responses, risk level, and importance confidence and readiness scores. They complete the Assist and Arrange elements during the consultation, supported by a directory of local/national patient support services before printing information tickets for the patient to keep. The HealthEir intervention has been successfully rolled out at eight pilot pharmacy sites nationally, with a mix of urban/rural sites, and independent/chain pharmacies.ConclusionsAdopting an interdisciplinary approach based on human-centred design principles led to the development of a blended brief intervention that has been successfully introduced in pilot sites across Ireland. While the implementation has been smooth despite COVID-19 challenges, and initial feedback has been very positive, the impact cannot yet be fully evaluated as research is ongoing. Future work will involve extending the intervention to include other healthcare professionals.

A Brief Psychological Intervention for Chronic Pain in Primary Care: A Pilot Randomized Controlled Trial.

Although evidence-based psychological interventions improve chronic pain, many patients do not engage in behavioral health services. Offering a brief intervention in a medical setting may provide benefits to patients with chronic pain. The purpose of this study was to examine preliminary outcomes of a brief psychological intervention for chronic pain delivered in primary care. Pilot randomized controlled trial. Primary care clinic. Sixty participants with chronic pain were randomized to a 5-session psychological intervention or treatment-as-usual control group. Participants completed pre- and post-intervention measures assessing pain severity, pain interference, pain catastrophizing, depression, and anxiety. Most participants (76.7%) randomized to the intervention completed all sessions. Compared to the control group, those in the intervention had decreases in pain severity (P = .048), pain catastrophizing (P = .04), and depression (P = .01) from pre- to post-intervention. Within the intervention group, there was a significant improvement in pain interference scores (P = 0.02). Within the intervention group, effect sizes were medium to large for changes in pain severity, pain interference, pain catastrophizing, and depression scores. There were no significant changes in anxiety scores. Results suggest that delivery of a brief psychological intervention for chronic pain in primary care appears to offer improvements in pain severity, pain interference, pain catastrophizing, and depression. Findings suggest that shorter-term psychological interventions may offer similar benefits as longer-term ones. Furthermore, offering a brief intervention in primary care may increase access and engagement in behavioral pain management services. Future research should examine this through a fully-powered trial with longer-term outcomes.

Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use

BackgroundApproximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3–4; =5–7; =8–12), and the role of alcohol risk level and other factors in predicting receipt of BI. MethodsFrom administrative data (2010–2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. ResultsWhile almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. ConclusionsGiven that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.

Economic evaluations of public health interventions for mental health: A systematic literature review

Abstract Background To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. Methods A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between 2000 and 2018. The studies were identified through Medline, PsychINFO, Web of Science. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Results Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and 4 interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Conclusions Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited. Key messages Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society. Evidence on the cost-effectiveness of suicide prevention is limited.

Economic Evaluations of Public Health Interventions to Improve Mental Health and Prevent Suicidal Thoughts and Behaviours: A Systematic Literature Review

To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between January 2000 and November 2018. The studies were identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and four interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective based on the conclusions from original papers. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited.

Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis.

AimsTo assess the effectiveness of brief interventions in primary care aimed at reducing or discontinuing long‐term benzodiazepine/Z‐drug (BZRA) use.MethodSystematic review of randomized controlled trials of brief interventions in primary care settings aimed at reducing or discontinuing long‐term BZRA use in adults taking BZRAs for ≥ 3 months. Four electronic databases were searched: PubMed, EMBASE, PsycINFO and CENTRAL. The primary outcome was BZRA use, classified as discontinuation or reduction by ≥ 25%. The Theoretical Domains Framework (TDF) was used to retrospectively code behavioural determinants targeted by the interventions. The Behaviour Change Technique (BCT) Taxonomy was used to identify the interventions’ active components. Study‐specific estimates were pooled, where appropriate, to yield summary risk ratios (RRs) and 95% confidence intervals (CIs). Pearson's correlations were used to determine the relationship between intervention effect size and the results of both the TDF and BCT coding.ResultsEight studies were included (n = 2071 patients). Compared with usual care, intervention patients were more likely to have discontinued BZRA use at 6 months (eight studies, RR = 2.73, 95% CI = 1.84–4.06) and 12 months post‐intervention (two studies, RR = 3.41, 95% CI = 2.22–5.25). TDF domains ‘knowledge’, ‘memory, attention and decision processes’, ‘environmental context and resources’ and ‘social influences’ were identified as having been included in every intervention. Commonly identified BCTs included ‘information about health consequences’, ‘credible source’ and ‘adding objects to the environment’. There was no detectable relationship between effect size and the results of either the TDF or BCT coding.ConclusionBrief interventions delivered in primary care are more effective than usual care in reducing and discontinuing long‐term benzodiazepine/Z‐drug use.

Facilitating Screening and Brief Interventions in Primary Care: A Systematic Review and Meta-Analysis of the AUDIT as an Indicator of Alcohol Use Disorders.

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) was developed for use in primary health care settings to identify hazardous and harmful patterns of alcohol consumption, and is often used to screen for alcohol use disorders (AUDs). This study examined the AUDIT as a screening tool for AUDs.MethodsA systematic literature search was performed of electronic bibliographic databases (CINAHL, Embase, ERIC, MEDLINE, PsycINFO, Scopus, and Web of Science) without language or geographic restrictions for original quantitative studies published before September 1, 2018, that assess the AUDIT's ability to screen for AUDs. Random‐effects meta‐regression models were constructed by sex to assess the potential determinants of the AUDIT's specificity and sensitivity. From these models and ecological data from the Global Information System on Alcohol and Health, the true‐ and false‐positive and true‐ and false‐negative proportions were determined. The number of people needed to be screened to treat 1 individual with an AUD was estimated for all countries globally where AUD data exist, using a specificity of 0.95.ResultsA total of 36 studies met inclusion criteria for the meta‐regression. The AUDIT score cut‐point was significantly associated with sensitivity and specificity. Standard drink size was found to affect the sensitivity and specificity of the AUDIT for men, but not among women. The AUDIT performs less well in identifying women compared to men, and countries with a low prevalence of AUDs have higher false‐positive rates compared to countries with a higher AUD prevalence.ConclusionsThe AUDIT does not perform well as a screening tool for identifying individuals with an AUD, especially in countries and among populations with a low AUD prevalence (e.g., among women), and thus should not be used for this purpose.

The Cochrane 2018 Review on Brief Interventions in Primary Care for Hazardous and Harmful Alcohol Consumption: A Distillation for Clinicians and Policy Makers.

An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference -20 g/wk, 95% confidence interval -28 to -12). Subgroup analysis showed a similar effect for men and women. Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.

Facilitating Screening and Brief Interventions in Primary Care: A Systematic Review and Meta-Analysis of the Audit as an Indicator of Alcohol Use Disorders

Background: The Alcohol Use Disorders Identification Test (AUDIT) is relatively quick to administer and was developed for use in primary health care settings to identify hazardous drinking and potential alcohol use disorders (AUDs). We aimed to examine the AUDIT as a screening tool for AUDs and alcohol dependence, determine the optimal cut-points and determinants, and apply these cut-points to estimate, by sex and country, the number of people needed to be screened in order to treat one individual with an AUD. Methods: We conducted a systematic literature search for original quantitative studies that administered the AUDIT, identified the prevalence of current AUDs, reported the sensitivity and specificity of the AUDIT by sex, and specified the cut-point(s) used to obtain the respective sensitivity and specificity estimates. Several electronic bibliographic databases (CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus, and Web of Science) were systematically searched for studies published before September 1, 2018, without language or geographic restrictions. We performed cut-point-specific random-effects meta-analyses for both sensitivity and specificity for both sexes, conducted random-effects meta-regression models to determine potential determinants, and estimated true and false positive and true and false negative proportions, as well as the number of people needed to be screened to treat one individual with an AUD. Findings: A total of 36 studies were retained for data extraction. Standard drink size was found to affect the optimal cut-point for identifying AUDs among men, but not among women. The performance of the AUDIT is affected by the prevalence of AUDs; it performs less well in identifying women compared to men, and countries with a low prevalence have higher false positive rates compared to countries with a higher prevalence. Interpretation: The AUDIT does not perform well as a screening tool for identifying individuals with an AUD. Alternative forms of screening should be considered and evaluated for use in primary health care settings. Funding: Funding for this research was provided by the Pan American Health Organization. Declaration of Interest: We declare no competing interests.

Screening in Primary Care for Alcohol Use Compared With Smoking, Diet, and Physical Activity: A Repeated Population Survey in Sweden

Screening and brief intervention in primary care for hazardous alcohol use is potentially a means to improve public health but is seldom implemented. There are few comparisons with general practitioner screening for other lifestyle habits. Repeated cross-sectional surveys from 2004, 2008, and 2012 in Sweden were used (N = 28,935) to document general practitioner visitors' reports on being asked and advised about alcohol, tobacco, diet, and physical activity when visiting primary care. Screening increased for all health behaviors, with the most apparent increase found for alcohol use. Screening for alcohol use can efficiently be integrated into health care, along with that for other lifestyle habits.