Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care.
Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care.
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DOI：
10.1016/j.drugalcdep.2022.109458
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发表时间：
2022-06-01
影响因子：
4.2
通讯作者：
Sterling, Stacy A.
中科院分区：
文献类型：
--
作者：
Chi, Felicia W.;Parthasarathy, Sujaya;Palzes, Vanessa A.;Kline-Simon, Andrea H.;Metz, Verena E.;Weisner, Constance;Satre, Derek D.;Campbell, Cynthia I.;Elson, Joseph;Ross, Thekla B.;Lu, Yun;Sterling, Stacy A.
关键词：
成人初级保健中的酒精筛查、短暂干预和转诊治疗（SBIRT）是一项以证据为基础的公共卫生策略，旨在解决不健康的酒精使用问题，但缺乏酒精短暂干预（ABI）在现实世界中实施的有效性证据。我们使用纵向电子健康记录数据，拟合具有逆概率加权的边缘结构模型，以估计ABI对12个月饮酒结果的因果影响，该数据针对312，056名成年人，这些成年人在2014年至2017年间对不健康饮酒筛查结果呈阳性。实施系统性初级保健的SBIRT。我们研究了ABI的影响，调整和不调整接受专业酒精使用障碍（AUD）治疗，以及是否影响患者的人口统计学特征和酒精使用模式。接受ABI治疗后，重度饮酒天数（平均差异[95%CI] =-0.26 [-0.45，-0.08]）、每周饮酒天数（-0.04 [-0.07，-0.01]）、每天饮酒量（-0.05 [-0.08，-0.02]）和每周饮酒量（-0.16 [-0.27，-0.04]）的减少幅度更大。ABI对12个月饮酒结果的影响因基线消费水平、年龄组和患者是否已经有AUD而异，饮酒水平仅超过每日限制、年轻和没有AUD的患者改善更好。成人初级保健中的系统性ABI有可能在个人和人群水平上大大减少不健康饮酒人群的饮酒。需要更多的研究来帮助优化ABI，特别是将其调整为不同的亚群，并研究其长期的公共卫生影响。
Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. We fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns. Receiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = −0.26 [−0.45, −0.08]), drinking days per week (−0.04 [−0.07, −0.01]), drinks per drinking day (−0.05 [−0.08, −0.02]) and drinks per week (−0.16 [−0.27, −0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD. Systematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.
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