Addressing alcohol problems in primary care: A cluster randomized, controlled trial of a systems intervention - The screening and intervention in primary care (SIP) study
Addressing alcohol problems in primary care: A cluster randomized, controlled trial of a systems intervention - The screening and intervention in primary care (SIP) study
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DOI：
10.7326/0003-4819-138-5-200303040-00006
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发表时间：
2003-03-04
影响因子：
39.2
通讯作者：
Samet, JH
中科院分区：
文献类型：
--
作者：
Saitz, R;Horton, NJ;Samet, JH
背景：酒精问题的筛查和干预可以减少饮酒及其后果，但往往得不到实施。目的：测试向医生提供患者的酒精筛查结果和简单的个性化建议是否会影响医生在初级保健就诊期间与患者讨论酒精的可能性，以及是否会影响随后的酒精使用。设计：整群随机对照试验。背景：城市学术初级保健实践。参与者：41名教职员工和住院初级保健医生和312名危险饮酒患者。干预：向医生提供酒精筛查结果(笼子问卷回答，酒精消费，结果：在312名就诊的患者中，240名就诊的教职医生中，301名(97%)在就诊后完成了结果评估，236名(76%)接受了6个月的随访。干预组的专科医生比对照组的专科医生更倾向于向患者提供饮酒方面的建议(调整比例，[95%CI，47%至79%]比42%[CI，33%至53%])，并讨论与饮酒有关的问题(74%[CI，59%至85%]对51%[CI，39%至62%])。住院医生的建议和讨论在不同的组之间没有不同。6个月后，在干预组中看住院医生的患者每天饮酒量减少(调整后的平均饮酒量，3.8[CI，1.9~5.71比11.6[CI，5.4~17.7])。结论：虽然不同医生的培训水平似乎有不同的效果，但向医生提供酒精筛查结果和行动建议可以适度增加对酒精使用的讨论和对患者的建议，并可能减少饮酒。
Background: screening and intervention for alcohol problems can reduce drinking and its consequences but are often not implemented.Objective: To test whether providing physicians with patients' alcohol screening results and simple individualized recommendations would affect the likelihood of a physician's having a discussion with patients about alcohol during a primary care visit and would affect subsequent alcohol use.Design: Cluster randomized, controlled trial.Setting: Urban academic primary care practice.Participants: 41 faculty and resident primary care physicians and 312 patients with hazardous drinking.Interventions: Providing physicians with alcohol screening results (CAGE questionnaire responses, alcohol consumption, and readiness to change) and recommendations for their patients at a visit.Measurements: Patient self-report of discussions about alcohol use immediately after the physician visit and alcohol use 6 months later.Results: Of 312 patients, 240 visited faculty physicians, 301 (97%) completed the outcome assessment after the office visit, and 236 (76%) were followed for 6 months. Faculty physicians in the intervention group tended to be more likely than faculty physicians in the control group to give patients advice about drinking (adjusted proportion, 64% [95% CI, 47% to 79%] vs. 42% [CI, 33% to 53%]) and to discuss problems associated with alcohol use (74% [CI, 59% to 85%] vs. 51% [CI, 39% to 62%]). Resident physicians' advice and discussions did not differ between groups. Six months later, patients who saw resident physicians in the intervention group had fewer drinks per drinking day (adjusted mean number of drinks, 3.8 [CI, 1.9 to 5.71 versus 11.6 [CI, 5.4 to 17.7]).Conclusions: Although effects seem to differ by physician level of training, prompting physicians with alcohol screening results and recommendations for action can modestly increase discussions about alcohol use and advice to patients and may decrease alcohol consumption.