Brief Intervention for Heavy Drinking in Primary Care: Role of Patient Initiation.
Brief Intervention for Heavy Drinking in Primary Care: Role of Patient Initiation.
复制标题
DOI：
10.1097/adm.0000000000000141
复制
发表时间：
2015-09
影响因子：
5.5
通讯作者：
Helzer JE
中科院分区：
文献类型：
--
作者：
Rose GL;Guth SE;Badger GJ;Plante DA;Fazzino TL;Helzer JE
初级保健(PC)中的酒精短暂干预(BI)是有效的，但尽管多次努力增加提供者发起的BI，但仍未得到充分利用。促进BI的另一种方法是促使患者发起与酒精相关的讨论。关于患者在BI分娩中的作用，人们知之甚少。确定PC患者报告与其提供者发起BI的特征，并评估发起者(患者与提供者)与BI后饮酒之间的关联。在临床试验的背景下，在PC访问期间接受BI的患者(N=267)报告了BI的启动方式、改变的准备情况、人口统计学和最近的饮酒史。在BI后6个月再次评估饮酒情况。接受BI的患者中有50%报告说自己发起了饮酒的讨论。与那些报告提供者发起讨论的人相比，自我启动者明显更年轻(43.7比47.1，p=.03)，更有可能满足当前严重抑郁症的DSM标准(24%比14%，p=.04)，更有可能报告酒精戒断症状(68%比52%，p<；.01)。基线准备改变、基线饮酒率和当前DSM-IV酒精依赖在不同组之间没有差异。在BI后的两到三周内，自我启动者报告每周饮酒(5.7比2.4，p=.02)和每周饮酒天数(1.0比0.3，p=.002)减少得更多。在6个月的随访中，自我启动者与提供者发起BI的人相比，每周饮酒的减少幅度明显更大(p=0.002)。患者发起的BI和提供者发起的BI发生的频率相同，患者发起的BI与酒精使用的更大减少相关。未来在PC中提高BI比率的努力应该包括关注促使患者发起与酒精相关的讨论。
Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized in spite of multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery. To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between initiator (patient vs. provider) and drinking following a BI. In the context of clinical trial, patients (N=267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months following the BI. Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 vs. 47.1, p=.03), more likely to meet DSM criteria for current major depression (24% vs. 14%, p=.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs. 52%, p<.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the two-to-three weeks following BI, self-initiators reported greater decreases in drinks per week (5.7 vs. 2.4, p=.02), and drinking days per week (1.0 vs. 0.3, p=.002). At six month follow up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (p=.002). Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.
影响因子：
2
作者：
Rose GL;Plante DA;Thomas CS;Denton LJ;Helzer JE
通讯作者：
Helzer JE