- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT01602172
Health Behavior Change for Hospitalized Veterans
Trial of Nurse-delivered Alcohol Brief Intervention for Hospitalized Veterans
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Improving the identification and management of alcohol misuse is a VA priority. Alcohol misuse includes the spectrum of alcohol consumption ranging from hazardous drinking to alcohol use disorders (alcohol abuse and dependence). The VA recommends using a set of clinical strategies referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify and address alcohol misuse in primary care settings. Brief intervention (BI), a core component of SBIRT, significantly reduces alcohol consumption, morbidity, and healthcare utilization in hazardous drinkers, but its efficacy is not well-established outside of outpatient settings. In the hospital setting, nurses are well-positioned to deliver BI, but research is needed to determine the efficacy of inpatient nurse-delivered BI, particularly with hazardous drinkers. The few previous trials of BI in the inpatient setting demonstrated limited effects on alcohol consumption and alcohol-related problems, potentially due to assessment reactivity--extensive patient assessment that inadvertently raises patient awareness about drinking in both groups, mimicking the effect of BI and thus driving findings towards the null. Additionally, very few of these trials involved nurse delivery of the intervention and many included patients with alcohol use disorders, patients believed to be beyond the "therapeutic reach" of BI.
The primary goal of this 3-arm randomized controlled trial is to examine the efficacy of nurse-delivered alcohol BI with hospitalized patients who are hazardous drinkers and to identify barriers and facilitators to implementation of BI in inpatient settings. Arm 1 (BI) consists of Veterans randomized to nurse-delivered BI, Arm 2 (AC) consists of Veterans randomized to an attention control, and Arm 3 (AC-LA) consists of Veterans randomized to an attention control with limited assessment of readiness to change and adverse consequences of alcohol use so as to reduce and evaluate assessment reactivity.
Specific Aim 1 is to determine the impact of a nurse-led BI on the alcohol screening status, number of drinks/week, number of binge drinking episodes, readiness to change drinking behavior, and adverse consequences of alcohol use in hospitalized hazardous drinkers. Specific Aim 2 is to formatively evaluate the process of the intervention implementation to inform the design and execution of a future, multi-site randomized effectiveness trial of the intervention. A secondary aim is to identify factors, issues, and themes related to Veterans' interest and motivation for changing their alcohol consumption.
We will recruit 320 hospitalized Veterans admitted to one of the three medical-surgical units at the VA Pittsburgh Healthcare System. Veterans will be included who are >21 years old, able to speak English, and are hazardous, non-dependent drinkers, as defined by criteria established by the National Institute for Alcohol Abuse and Alcoholism and by the Composite International Diagnostic Interview Substance Abuse Module. Patients randomized to Arm 1 will receive a three-part nurse-delivered BI. Patients randomized to Arms 2 and 3 will receive usual care plus healthy lifestyle brochures addressing general healthy lifestyle behaviors, such as limited alcohol consumption, tobacco cessation, and weight management. For Specific Aim 1, we will use various multivariable linear and logistic regressions that account for continuous outcomes, dichotomous outcomes, and clustering within medical units. Poisson regressions or negative binomial regressions will be used if the continuous outcome measures are not normally distributed. For Specific Aim 2, we will use basic descriptive statistics in order to describe the numbers of deviations and interruptions to intervention delivery as planned. Based on interventionist field notes, we will categorize the types of deviations/interruptions. We will also use these descriptive statistics to describe duration of the audio-recorded intervention; the presence/absence of various techniques within the BI; the receipt/nonreceipt of additional alcohol feedback, advice, or counseling; and patient responsiveness to/perceptions of the BI. We will also code brief free-text perceptions responses using a modified grounded theory approach.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, Estados Unidos, 15240
- VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
-
-
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- U.S. Veterans admitted to one of the three medical-surgical units at VA Pittsburgh Healthcare System (VAPHS)
- age 21 years or older
- ability to speak English
- hazardous, non-dependent alcohol consumption
Exclusion Criteria:
- Alcohol dependence (as determined using Section C (Alcohol) from the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)
- Current participation (past 6 months) in substance abuse treatment or 12-step program
- age <21 years
- significant cognitive impairment (as determined by the Short Blessed test , score >10)
- bipolar disorder or active psychosis
- sensory impairment precluding communication
- medically-related inability to participate or consent to study participation
- current pregnancy
- current incarceration
- lack of telephone access or unwillingness to be contacted for follow-up
- enrollment in the study during a prior inpatient admission at VAPHS
- current enrollment in other substance use trials (due to the potential influence of dual participation on study outcomes)
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Investigación de servicios de salud
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Doble
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
---|---|
Experimental: Brief Alcohol Intervention (BI)
The 3-part Brief Intervention (BI) consists of .
Part I is 15-minute multi-component motivational discussion in hospital which includes personalized risk feedback, advice to abstain or reduce consumption, and the negotiation of an individual change plan.
Part II is 15-minute follow-up in hospital to reinforce Part I. Part III is 15-minute follow-up telephone call at 2 weeks to reinforce Part I.
|
3 part intervention: Part I is 15-minute multi-component motivational discussion in hospital which includes personalized risk feedback, advice to abstain or reduce consumption, and the negotiation of an individual change plan.
Part II is 15-minute follow-up in hospital to reinforce Part I. Part III is 15-minute follow-up telephone call at 2 weeks to reinforce Part I.
|
Comparador activo: Attention Control
These subjects receive a set of Lifestyle brochures which contain information and tips for healthy lifestyle behaviors such as alcohol and tobacco use, weight management, and physical activity.
Two weeks later, the Research Assistant calls subjects in this condition at home for a 5-15 minute session to review the brochures and discuss any questions that s(he) may have.
This intervention is designed to provide all the information and assessments that that Brief Intervention participants as well as all the alcohol consumption and motivation to change measures-- it is designed to control for the attention that the BI participants receive w/o the motivational interventions
|
Set of educational brochures/brochures which contain information and tips for healthy lifestyle behaviors such as alcohol and tobacco use, weight management, and physical activity to discuss with the Research Assistant.
Approximately two weeks later, the Research Assistant will call patients in this condition at home for a 5-15 minute session to review the brochures and discuss any questions that s(he) may have.
|
Comparador activo: Control
These subjects receive a set of Lifestyle brochures which contain information and tips for healthy lifestyle behaviors such as alcohol and tobacco use, weight management, and physical activity to discuss with the Research Assistant.
Approximately two weeks later, the Research Assistant will call patients in this condition at home for a 5-15 minute session to review the brochures and discuss any questions that s(he) may have.
Subjects complete only drinking quantity measures at baseline and 6 months post baseline.
The inclusion of this group tests whether completing more extensive questionnaires (in comparison the Attention Control group) decreases alcohol consumption.
|
Set of educational brochures/brochures which contain information and tips for healthy lifestyle behaviors such as alcohol and tobacco use, weight management, and physical activity to discuss with the Research Assistant.
Approximately two weeks later, the Research Assistant will call patients in this condition at home for a 5-15 minute session to review the brochures and discuss any questions that s(he) may have.
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Number of Standard Drinks Per Week
Periodo de tiempo: 6 months
|
Number of Drinks per Week was determined by the product of responses to the following two NIAAA questions during the recruitment and screening processes : (1) On average, how many days a week do you have an alcoholic drink?; (2) On a typical drinking day, how many standard-sized drinks do you have?
(Appendix 2).
"Standard-sized drink" will refer to 12 ounces beer, 5 ounces wine, or 1.5 ounces liquor/spirits.
|
6 months
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Alcohol Screening Status
Periodo de tiempo: 6 months
|
Alcohol Screening Status will be assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) (Appendix 2), the 3-item short form of the 10-item Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization.
AUDIT-C data will be collected during the recruitment and screening processes.
AUDIT-C scores range from 0-12, with higher values representing a worse outcome (a score of 4 indicating hazardous drinking in males and 3 hazardous drinking in females).Generally, the higher the AUDIT-C score, the more likely it is that the patient's drinking is affecting his/her health and safety.
|
6 months
|
Number of Binge Drinking Episodes Over Past 30 Days
Periodo de tiempo: 6 months
|
Number of Binge Drinking Episodes will be assessed through a third NIAAA question during the recruitment and screening processes: (3) How many times in the past 30 days have you had 5 or more standard-sized drinks in a day (men), or 4 or more standard-sized drinks in a day?
(women)
|
6 months
|
Readiness to Change Drinking Behavior
Periodo de tiempo: 6 months
|
We will assess readiness to change with the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Version 8.This instrument was created by one of the initial developers of Motivational Interviewing, the therapeutic style on which SBIRT is based.
SOCRATES is a 19-item instrument with 3 subscales where minimum score is 19 and the maximum score is 95.
Lower totals representing lesser readiness/eagerness for change and higher totals representing greater readiness/eagerness to change.
With the three sub scales (Recognition, Ambivalence, and Taking Steps), higher scores indicate greater recognition, ambivalence and taking steps and scores range from 7 to 35, 4 to 20, and 8 to 40, respectively.
|
6 months
|
Adverse Consequences of Alcohol Use
Periodo de tiempo: 6 months
|
We will assess adverse consequences of alcohol use with the Short Inventory of Problems (SIP-2R), a widely used 15-item stand-alone short version of the Drinker Inventory of Consequences (DrInC).The SIP-2R will be administered at baseline (for BI and Attention Control) and at 6 months post-hospital discharge (all groups) to assesses adverse consequences of alcohol use over the past three months in five areas: Interpersonal, Physical, Social, Impulsive, and Intrapersonal.
The SIP-2R was used as a continuous measure with possible scores from 0-45, where each item has a score from 0-3 (0=Never, 1=once or a few times, 2=once or twice a week, 3=daily or almost daily).
Higher scores indicate a worse outcome.
|
6 months
|
Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Number of Participants Who Were Interested and Motivated to Change Their Alcohol Consumption
Periodo de tiempo: Baseline
|
Among Veterans randomized to Arm 1, we will analyze the transcripts of Part I of the audio-recorded brief intervention.
Descriptive statistics (e.g., frequency distributions, measures of central tendency) will be used to characterize the anonymous sociodemographic, educational, and patient care characteristics of the participants.
Transcript data will be analyzed using the grounded theory technique of constant comparison.
Similar or related codes will be collapsed into focused codes in order to represent interrelationships, variations, and underlying patterns in the data, allowing for the identification of factors, issues, and themes related to Veterans interest and motivation for changing their alcohol consumption.
|
Baseline
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Lauren M. Broyles, PhD RN, VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Publicaciones y enlaces útiles
Publicaciones Generales
- Broyles LM, Wieland ME, Confer AL, Youk AO, Gordon AJ. Holes in the pipeline: addressing recruitment challenges for an alcohol brief intervention trial in the acute care setting. [Abstract]. Substance Abuse. 2014 Jan 1; 35(2):208.
- Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial. Addict Sci Clin Pract. 2015 May 13;10(1):13. doi: 10.1186/s13722-015-0033-6.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- NRI 11-339
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
Ensayos clínicos sobre Consumo de alcohol
-
Karolinska InstitutetTerminadoConsumo de alcohol | Dependencia al alcohol | Alcohol; Uso nocivo | Trastorno por consumo de alcohol | Abuso de alcoholSuecia
-
Charles Drew University of Medicine and ScienceRetiradoConsumo de alcohol | Trastorno por consumo de alcohol | Abuso de alcohol | Problema de alcohol
-
Boston Medical CenterBoston University; National Institute on Alcohol Abuse and Alcoholism (NIAAA)TerminadoDependencia al alcohol | Abuso de alcohol | Uso no saludable de alcohol | Cantidades peligrosas de consumo de alcohol | Uso peligroso de alcoholEstados Unidos
-
University of Auckland, New ZealandTe Hiringa Hauora/Health Promotion AgencyTerminadoBebiendo alcohol | Consumo, AlcoholNueva Zelanda
-
HBSAReclutamientoConsumo excesivo de alcohol, consumo de alcohol por menores de edad, beber y conducir, daños relacionados con el alcoholEstados Unidos
-
Karolinska InstitutetRegion StockholmTerminadoDependencia al alcohol | Trastorno por consumo de alcohol | Abuso de alcohol | Uso nocivo de alcoholSuecia
-
University of WashingtonNational Institute on Alcohol Abuse and Alcoholism (NIAAA)Activo, no reclutandoAlcohol; uso, problemaEstados Unidos
-
University of WashingtonNational Institute on Alcohol Abuse and Alcoholism (NIAAA)TerminadoAlcohol; uso, problemaEstados Unidos
-
Karolinska InstitutetRegion Stockholm; Public Health Agency of SwedenTerminadoTratamiento anónimo en Internet para la dependencia del alcohol: un ensayo aleatorizado y controladoDependencia al alcohol | Trastorno por consumo de alcohol | Abuso de alcohol | Uso nocivo de alcoholSuecia
-
University of Central FloridaInscripción por invitación
Ensayos clínicos sobre Brief Alcohol Intervention
-
University of SalamancaTerminado
-
University of OxfordOxford University Hospitals NHS TrustDesconocidoSíntomas de comportamientoReino Unido
-
Assistance Publique - Hôpitaux de ParisAún no reclutandoPérdida de la audición | Función cognitiva | Función ejecutiva | Función vestibularFrancia
-
Munich Municipal HospitalTechnical University of Munich; University of RegensburgDesconocido
-
Shiraz University of Medical SciencesTerminado
-
Heidelberg UniversityDesconocidoRetraso de idioma | Trastornos del desarrollo del lenguajeAlemania
-
Ottawa Heart Institute Research CorporationCanadian Institutes of Health Research (CIHR)Activo, no reclutandoDependencia a la nicotina, cigarrillos | Abstinencia de nicotinaCanadá
-
IWK Health CentreCanadian Institutes of Health Research (CIHR)TerminadoTrastorno de oposición desafiante | Trastorno de conductaCanadá
-
The Hospital for Sick ChildrenTerminadoObesidad infantilCanadá
-
Alberto PilottoAún no reclutandoPersonas mayores | Enfermedades Crónicas No Transmisibles