Effect of a primary care based brief intervention trial among risky drug users on health-related quality of life

Abstract

Background: Improvement in quality of life (QOL) is a long term goal of drug treatment. Although some brief interventions have been found to reduce illicit drug use, no trial among adult risky (moderate non-dependent) drug users has tested effects on health-related quality of life.

Methods: A single-blind randomized controlled trial of patients enrolled from February 2011 to November 2012 was conducted in waiting rooms of five federally qualified health centers. 413 adult primary care patients were identified as risky drug users using the WHO-ASSIST and 334 (81% response; 171 intervention, 163 control) consented to participate in the trial. Three-month follow-ups were completed by 261 patients (78%). Intervention patients received the QUIT intervention of brief clinician advice and up to two drug-use health telephone sessions. The control group received usual care and information on cancer screening. Outcomes were three-month changes in the Short Form Health Survey (SF-12) mental health component summary score (MCS) and physical health component summary score (PCS).

Results: The average treatment effect (ATE) was non-significant for MCS (0.2 points, p-value=0.87) and marginally significant for PCS (1.7 points, p-value=0.08). The average treatment effect on the treated (ATT) was 0.1 (p-value=0.93) for MCS and 1.9 (p-value=0.056) for PCS. The effect on PCS was stronger at higher (above median) baseline number of drug use days: ATE=2.7, p-value=0.04; ATT=3.21, p-value=0.02.

Conclusions: The trial found a marginally significant effect on improvement in PCS, and significant and stronger effect on the SF-12 physical component among patients with greater frequency of initial drug use.

Keywords: Brief intervention; Illicit drug use; Primary care clinics; Quality of life; Screening.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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Association between change in MCS and change in HSD from baseline to follow-up. P-value for ‘change in days of HSD drug use’: 0.047.Fractional polynomial regression models adjusted for baseline values of each outcome, baseline days of HSD use, age, sex, race/ethnicity, the interval between the baseline and follow-up assessments, and four dummy clinic variables. MCS, SF-12 mental component summary score. HSD, highest scoring drug