A Brief Intervention Reduces Hazardous and Harmful Drinking in Emergency Department Patients
A Brief Intervention Reduces Hazardous and Harmful Drinking in Emergency Department Patients
复制标题
DOI：
10.1016/j.annemergmed.2012.02.006
复制
发表时间：
2012-08-01
影响因子：
6.2
通讯作者：
O'Connor, Patrick G.
中科院分区：
文献类型：
--
作者：
D'Onofrio, Gail;Fiellin, David A.;O'Connor, Patrick G.
研究目的：已经证明，简单的干预措施可以减少酒精使用，改善危险和有害饮酒者的预后，但支持其在急诊科（艾德）患者中使用的证据有限。在简短干预研究中使用研究评估可能会导致其有效性的不确定性。因此，我们试图确定（1）如果一个紧急急救人员进行简短的谈判面试或简短的谈判面试与助推器减少酒精消费量相比，标准的护理;和（2）研究评估的影响饮酒的结果，使用标准的护理无评估group.Methods：我们随机889成人艾德患者危险和有害的饮酒。共有740人接受了紧急咨询师进行的简短谈判访谈（n=297），简短谈判访谈与1个月的随访电话助推器（简短谈判访谈与助推器）（n=295），或标准治疗（n=148）。我们还纳入了一个标准治疗，没有评估（n=149）组，以检查评估对饮酒结果的影响。采用混合模型程序分析的主要结果包括通过交互式语音应答收集的过去7天的饮酒量和6个月和12个月时28天的暴饮暴食事件。次要结果包括通过电话调查收集的负面健康行为和后果。在与助推器的简短谈判访谈中，从基线到6个月和12个月，过去7天的平均饮酒次数减少显著更大（从20.4 [95%置信区间{CI} 18.8至22.01至11.6 [95% CI 9.7至13.5]至13.0 [95% CI 10.5至15.5]）和简短谈判访谈（从19.8 [95% CI 18.3 - 21.4]至12.7 [95% CI 10.8 - 14.6]至14.3 [95% CI 11.9 - 16.8]）（从20.9 [95% CI 18.7至23.2]至14.2 [95% CI 11.2至17.1]至17.6 [95% CI 14.1至21.2]）。在与助推器的简短谈判访谈中，28天暴食事件的减少也更大（从7.5 [95% CI 6.8至8.2]至4.4 [95% CI 3.6至5.2]至4.7 [95% CI 3.9至5.6]）和简短谈判访谈（从7.2 [95% CI 6.5 - 7.9]至4.8 [95% CI 4.0 - 5.6]至5.1 [95% CI 4.2 - 5.9]）（从7.2 [95% CI 6.2至8.2]至5.7 [95% CI 4.5至6.9]至5.8 [95% CI 4.6至7.0]）。与单独的简短谈判面试相比，与助推器一起进行的简短谈判面试没有显著的好处。标准护理组和标准护理-无评估组之间的饮酒结果没有差异。从基线到12个月，饮酒超过3杯后驾驶率的降低在简短谈判访谈中更大（38%至29%）和与助推器的简短谈判面试（39%至31%）组比标准治疗组（43%至42%）。在危险和有害饮酒者中，紧急酒精治疗师进行的简短干预可以减少饮酒和酒后驾驶的发生。这些结果支持在艾德环境中使用简短干预。[Ann 2012;60：181-192.]
Study objective: Brief interventions have been shown to reduce alcohol use and improve outcomes in hazardous and harmful drinkers, but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of brief interventions may contribute to uncertainty about their effectiveness. Therefore we seek to determine (1) if an emergency practitioner-performed Brief Negotiation Interview or a Brief Negotiation Interview with a booster reduces alcohol consumption compared with standard care; and (2) the impact of research assessments on drinking outcomes using a standard care-no-assessment group.Methods: We randomized 889 adult ED patients with hazardous and harmful drinking. A total of 740 received an emergency practitioner-performed Brief Negotiation Interview (n=297), a Brief Negotiation Interview with a 1-month follow-up telephone booster (Brief Negotiation Interview with booster) (n=295), or standard care (n=148). We also included a standard care with no assessments (n=149) group to examine the effect of assessments on drinking outcomes. Primary outcomes analyzed with mixed-models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months, collected by interactive voice response. Secondary outcomes included negative health behaviors and consequences collected by telephone surveys.Results: The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in the Brief Negotiation Interview with booster (from 20.4 [95% confidence interval {CI} 18.8 to 22.01 to 11.6 [95% CI 9.7 to 13.5] to 13.0 [95% CI 10.5 to 15.5]) and Brief Negotiation Interview (from 19.8 [95% CI 18.3 to 21.4] to 12.7 [95% CI 10.8 to 14.6] to 14.3 [95% CI 11.9 to 16.8]) than in standard care (from 20.9 [95% CI 18.7 to 23.2] to 14.2 [95% CI 11.2 to 17.1] to 17.6 [95% CI 14.1 to 21.2]). The reduction in 28-day binge episodes was also greater in the Brief Negotiation Interview with booster (from 7.5 [95% CI 6.8 to 8.2] to 4.4 [95% CI 3.6 to 5.2] to 4.7 [95% CI 3.9 to 5.6]) and Brief Negotiation Interview (from 7.2 [95% CI 6.5 to 7.9] to 4.8 [95% CI 4.0 to 5.6] to 5.1 [95% CI 4.2 to 5.9]) than in standard care (from 7.2 [95% CI 6.2 to 8.2] to 5.7 [95% CI 4.5 to 6.9] to 5.8 [95% CI 4.6 to 7.0]). The Brief Negotiation Interview with booster offered no significant benefit over the Brief Negotiation Interview alone. There were no differences in drinking outcomes between the standard care and standard care-no assessment groups. The reductions in rates of driving after drinking more than 3 drinks from baseline to 12 months were greater in the Brief Negotiation Interview (38% to 29%) and Brief Negotiation Interview with booster (39% to 31%) groups than in the standard care group (43% to 42%).Conclusion: Emergency practitioner-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in hazardous and harmful drinkers. These results support the use of brief interventions in ED settings. [Ann Emerg Med. 2012;60:181-192.]