The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) - A randomised control trial protocol
The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) - A randomised control trial protocol
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DOI：
10.1186/1472-6963-8-129
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发表时间：
2008-06-12
影响因子：
2.8
通讯作者：
Tober, Gillian
中科院分区：
文献类型：
--
作者：
Coulton, Simon;Watson, Jude;Tober, Gillian
背景：有大量证据表明过量饮酒的有害影响。在老年人群中，过量饮酒会增加患冠心病、高血压、中风和一系列癌症的风险。饮酒还与跌倒、早发痴呆和其他认知缺陷的风险增加有关。衰老过程中发生的生理变化意味着老年人在较低的饮酒水平下会遇到与酒精相关的问题。有强有力的证据表明，短期心理社会干预对于减少初级保健机构中机会主义人群的饮酒量是有效的。阶梯式护理干预措施包括仅向那些对较低强度干预措施没有反应的人群提供更强化的干预措施，并提供一种潜在的资源有效手段来满足该人群的需求。 方法/设计：该研究设计是一项务实的前瞻性多中心双臂随机对照试验。主要假设是，与随机分组后 12 个月时的最小干预相比，对老年危险酒精使用者进行分级护理干预可减少饮酒量。使用审计调查问卷来确定潜在的参与者。符合条件并同意的参与者以相同的概率随机接受最小干预或三步治疗方法。分步治疗方法包括步骤 1 行为改变咨询、步骤 2 三个疗程的动机增强治疗和步骤 3 转诊至专家服务。主要结果是使用每天的平均标准饮酒量来衡量的，次要结果指标包括饮酒问题指数、健康相关的生活质量和健康效用。该研究采用了全面的经济分析来评估干预措施的相对成本效益。讨论：本文提出了第一个实用随机对照试验的方案，评估初级保健中老年危险酒精使用者的阶梯式护理干预措施的有效性和成本效益。
Background: There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.Methods/design: The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.Discussion: The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.