A Health Technician-delivered Brief Intervention linked to AUDIT for reduction of alcohol use in Chilean primary care: a randomized controlled trial

Nicolas A Barticevic, Fernando Poblete, Soledad M Zuzulich, Victoria Rodriguez, Diego Quevedo, Brena F Sena, Laura Bradshaw, Nicolas A Barticevic, Fernando Poblete, Soledad M Zuzulich, Victoria Rodriguez, Diego Quevedo, Brena F Sena, Laura Bradshaw

Abstract

Background: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet.

Methods: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment.

Results: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66).

Conclusions: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://ichgcp.net/clinical-trials-registry/NCT02642757 .

Keywords: Alcohol brief intervention; Chile; Health technician; Primary care.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram [44]

References

    1. WHO. Global status report on alcohol and health 2018. 2018. .
    1. Ministerio de Salud Chile. Estudio de carga de enfermedad y carga atribuible. Ministerio de Salud de Chile; 2008, p. 101.
    1. Ministerio de Salud Chile. Estrategia Nacional sobre Alcohol: Reducción del consumo de riesgo y sus consecuencias sociales y sanitarias. 2010.
    1. Peña S, Sierralta P, Norambuena P, Leyton F, Pemjean A, Román F. Alcohol policy in Chile: a systematic review of policy developments and evaluations. Addiction. 2020 doi: 10.1111/add.15208.
    1. Poblete F, Barticevic NA, Zuzulic MS, Portilla R, Castillo-Carniglia Á, Sapag JC, et al. A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile. Addiction. 2017;112:78. doi: 10.1111/add.13808.
    1. WHO. Best buys and other recommended interventions for the prevention and control of noncommunicable diseases. 2017.
    1. Ministerio de Desarrollo social Chile. Ficha de seguimiento de programa DIR APS Alcohol, Tabaco y Otras drogas [DIR APS Alcohol, Tobacco and Other Drug Program Tracking Sheet]. . Accessed 4 Oct 2020
    1. Barticevic NA, Margozzini P. How many people with harmful alcohol use are benefiting from face-to-face interventions in chile? Addict Sci Clin Pract. 2018;13(1):16. doi: 10.1186/s13722-018-0121-5#Sec37.
    1. Borgero F, Zitko P, Norambuena P, Pemjean A. Evaluación preliminar programa de intervenciones breves para reducir el consumo de riesgo de alcohol. 2012. [Disertation] XXX Jornadas chilenas de salud pública escuela de salud pública Universidad de Chile
    1. Ramírez NA, Giovanella L, Romero RV, Silva HT, de Almeida PF, Ríos G, et al. Mapping primary health care renewal in South America. Fam Pract. 2016;33:261–267. doi: 10.1093/fampra/cmw013.
    1. Ayala RA, Fealy GM, Vanderstraeten R, Bracke P. Academisation of nursing: an ethnography of social transformations in Chile. Int J Nurs Stud. 2014;51:603–611. doi: 10.1016/j.ijnurstu.2013.08.010.
    1. Gaume J, McCambridge J, Bertholet N, Daeppen J-B. Mechanisms of action of brief alcohol interventions remain largely unknown—a narrative review. Fronti Psychiatry. 2014;5:108.
    1. Kaner EF, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Db Syst Rev. 2018;24:1680.
    1. Correa del Rio, M. R. Primary health care workers’ perspectives on the introduction of an alcohol brief intervention program in Chile. Masters Research thesis, Centre for Health and Society, Melbourne School of Population and Global Health, The University of Melbourne.
    1. Holder H, Flay B, Howard J, Boyd G, Voas R, Grossman M. Phases of alcohol problem prevention research. Alcohol Clin Exp Res. 1999;23:183–194. doi: 10.1111/j.1530-0277.1999.tb04043.x.
    1. Saitz R. The best evidence for alcohol screening and brief intervention in primary care supports efficacy, at best, not effectiveness: You say tomāto, I say tomăto? That’s not all it’s about. Addict Sci Clin Pract. 2014;9:14. doi: 10.1186/1940-0640-9-14.
    1. Miller WR, Rollnick S. Motivational interviewing. New York: The Guilford Press; 2012.
    1. Ministerio de Salud Chile. Intervenciones breves para reducir el consumo de alcohol de riesgo, guía técnica para la atención primaria. [Brief interventions to reduce risk of alcohol consumption, technical guide for primary care]. 2011. . Accessed 4 Oct 2020
    1. Barticevic NA. Efectividad de una intervención breve para disminuir el consumo de alcohol en pacientes con consumo de riesgo según AUDIT realizada por técnico paramédico en atención primaria [study protocol]. 2014. . Accessed 4 Oct 2020
    1. Alvarado M, Garmendia M, Acuña G, Santis R, Arteaga O. Validez y confiabilidad de la versión chilena del Alcohol Use Disorders Identification Test (AUDIT). Revista Médica De Chile. 2009;137:1463–8.
    1. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, for the Ambulatory Care Quality Improvement Project (ACQUIP). The AUDIT Alcohol Consumption Questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95. doi: 10.1001/archinte.158.16.1789
    1. Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97:279 292.
    1. R Core Team. R: A language and environment for statistical computing. 2008.
    1. Bates D, Mächler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models using lme4. Arxiv. 2014
    1. Barticevic NA. Brief Intervention by Health Technicians in Primary Care in Chile. n.d. Barticevic NL. Alcohol Brief Intervention by Health Technicians in Primary Care in Chile. OSF; 2020. . Accessed 12 Mar 2021
    1. Bazargan-Hejazi S, Bing E, Bazargan M, Der-Martirosian C, Hardin E, Bernstein J, et al. Evaluation of a brief intervention in an inner-city emergency department. Ann Emerg Med. 2005;46:67–76. doi: 10.1016/j.annemergmed.2004.10.014.
    1. Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, et al. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet. 2017;389:186–195. doi: 10.1016/S0140-6736(16)31590-2.
    1. Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Subst Abus Treat Prev Policy. 2015;10:46. doi: 10.1186/s13011-015-0042-1.
    1. Dhital R, Norman I, Whittlesea C, Murrells T, McCambridge J. The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction. 2015;110:1586 1594.
    1. Lane J, Proude E, Conigrave K, Boer JP, Haber P. Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients. Sex Transm Infect. 2008;84:524–7. doi: 10.1136/sti.2008.032482.
    1. Drummond C, Deluca P, Coulton S, Bland M, Cassidy P, Crawford M, et al. the effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial. Plos ONE. 2014;9:e99463. doi: 10.1371/journal.pone.0099463.
    1. Tait RJ, Hulse GK, Robertson SI. Effectiveness of a brief-intervention and continuity of care in enhancing attendance for treatment by adolescent substance users. Drug Alcohol Depen. 2004;74:289–296. doi: 10.1016/j.drugalcdep.2004.01.003.
    1. Mello MJ, Longabaugh R, Baird J, Nirenberg T, Woolard R. DIAL: a telephone brief intervention for high-risk alcohol use with injured emergency department patients. Ann Emerg Med. 2008;51:755–764. doi: 10.1016/j.annemergmed.2007.11.034.
    1. McCambridge J, Kypri K. Can simply answering research questions change behaviour? Systematic review and meta analyses of brief alcohol intervention trials. Plos ONE. 2011;6:e23748. doi: 10.1371/journal.pone.0023748.
    1. McCambridge J, Kypri K, McElduff P. Regression to the mean and alcohol consumption: a cohort study exploring implications for the interpretation of change in control groups in brief intervention trials. Drug Alcohol Depen. 2014;135:156–159. doi: 10.1016/j.drugalcdep.2013.11.017.
    1. Jenkins RJ, McAlaney J, McCambridge J. Change over time in alcohol consumption in control groups in brief intervention studies: systematic review and meta-regression study. Drug Alcohol Depen. 2009;100:107–114.
    1. Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, Gingrich R, et al. Screening for problem drinking and counseling by the primary care physician-nurse team. Alcohol Clin Exp Res. 1996;20:1443–1450. doi: 10.1111/j.1530-0277.1996.tb01147.x.
    1. McIntosh MC, Leigh G, Baldwin NJ, Marmulak J. Reducing alcohol consumption. Comparing three brief methods in family practice. Can Fam Physician Médecin De Fam Can. 1997;43(1959–62):1965–7.
    1. Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, et al. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ Br Med J. 2013;346:e8501. doi: 10.1136/bmj.e8501.
    1. Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet. 2002;359(696):700.
    1. Davis CG, Thake J, Vilhena N. Social desirability biases in self-reported alcohol consumption and harms. Addict Behav. 2010;35(302):311.
    1. Kypri K, Langley JD, Saunders JB, Cashell-Smith ML. Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking. Addiction. 2007;102:62–70. doi: 10.1111/j.1360-0443.2006.01632.x.
    1. Carpio C, Bench NS. The Health Workforce in Latin America and the Caribbean. The World Bank; 2015.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Bmc Med. 2010;8(1):18. doi: 10.1186/1741-7015-8-18.

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