Brief Substance Use Interventions in General Healthcare Settings: Understanding Variability in Effects

项目摘要/摘要 尽管有一些共识认为，在普通医疗环境中进行短暂干预(BI)可以减少 自我报告饮酒量有风险的患者，效果大小差异很大，大多数 患者继续饮用危险剂量的饮料，而且有许多无效研究。尽管对……缺乏了解 为什么BI效果在不同环境下会有如此大的差异，筛查和简短干预仍然是广泛推荐的 用于在一般健康环境中实施。知道什么管用，什么不管用，多少是必要的 为了达到预期的效果，以及在什么环境和情况下，BIS或多或少地发挥作用，已经变得至关重要。 因此，拟议的研究将使用元分析技术来分析影响的可变性 在一般医疗保健环境中提供的药物和酒精的国际清算系统。研究的具体目的是：1) 评估BIS对普通医疗保健中提供的药物和酒精的总体影响和影响的变异性 设置，2)根据积极干预成分、参与者检查BIS效果的变异性 特征、提供者和环境特征以及研究方法，以及3)创建预测的简档 国际清算银行在减少毒品和酒精使用方面最有效或最不有效的环境和环境。 拟议的研究将从实验研究语料库中汇编一个元分析数据库 检查国际清算银行在一般医疗保健环境中的影响。符合纳入条件的研究将包括 在一般医疗保健环境中提供的BI，旨在减少患者(成人)的药物或酒精使用 和青少年)接受了大量药物使用的筛查。在任何国家和地区进行的随机对照试验 以任何语言报告的报告都有资格被纳入。将提取详细信息和汇总数据 来自研究报告。还将为所有符合条件的研究收集个人参与者数据，以便在以下方面提供更多- 深入探讨不同类型患者干预效果的变异性。随机效果元- 具有稳健方差估计的分析和混合效应Meta回归模型将用于综合 研究结果，并创建预测配置文件，以确定BIS最多或最少的环境 有效。将使用一个由顾问组成的专家小组来指导这项研究，就数据收集和 数据分析战略，促进收集个别参与者的数据，并确保研究内容 对BI研究具有临床意义的患者档案。 拟议的研究结果将通过记录以下内容显著推进BI研究领域 以及探索BI效应中的可变性。目前在初级试验中不一致的发现呈现出 对于有兴趣在医疗保健环境中实施BIS的研究人员和从业者来说，这是一个挑战。本研究 将确定BIS可能最有效或最不有效的干预背景和患者概况，提供 为今后研究和实施这一形式的药物预防提供及时和有价值的指导 程序。

PROJECT SUMMARY/ABSTRACT Although there is some consensus that brief interventions (BI) in general medical settings can reduce self-reported alcohol consumption among patients who drink risky amounts, effect sizes vary widely, most patients continue to drink risky amounts, and there are many null studies. Despite the lack of understanding of why BI effects can vary so much across settings, screening and brief intervention are still widely recommended for implementation in general health settings. Knowing what works and what does not, how much is necessary to achieve desired effects, and in what settings and circumstances BIs work more or less, has become critical. The proposed study will therefore use meta-analytic techniques to analyze variability in the effects of BIs for drugs and alcohol delivered in general healthcare settings. The specific aims of the study are to 1) assess the overall effects and variability in effects of BIs for drugs and alcohol delivered in general healthcare settings, 2) examine variability in effects of BIs according to active intervention components, participant characteristics, provider and setting characteristics, and study methodology, and 3) create predicted profiles of the contexts and settings in which BIs may be most or least effective in reducing drug and alcohol use. The proposed study will compile a meta-analytic database from the corpus of experimental studies examining the effects of BIs in general healthcare settings. Studies eligible for inclusion will be those involving a BI delivered in a general healthcare setting, intended to reduce drug or alcohol use among patients (adults and youth) screened for heavy substance use. Randomized controlled trials conducted in any country and reported in any language will be eligible for inclusion. Detailed information and aggregate data will be extracted from study reports. Individual participant data will also be collected for all eligible studies, to permit more in- depth exploration of variability in intervention effects across different types of patients. Random-effects meta- analysis and mixed-effects meta-regression models with robust variance estimates will be used to synthesize findings across studies and create the predicted profiles identifying the contexts in which BIs are most or least effective. An expert panel of advisors will be used to guide the study, providing feedback on data collection and data analysis strategies, facilitating collection of individual participant data, and ensuring the study addresses clinically meaningful patient profiles for BI research. The results from the proposed study will significantly advance the field of BI research by documenting and exploring the variability in BI effects. Inconsistent findings across primary trials currently present a challenge for researchers and practitioners interested in implementing BIs in healthcare settings. This study will identify the intervention contexts and patient profiles for which BIs may be most or least effective, providing timely and valuable guidance for future research on and implementation of this form of drug prevention program.