|Titre :||Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis (2015)|
|Auteurs :||M. KEURHORST ; I. VAN DE GLIND ; M. BITARELLO DO. AMARAL-SABADINI ; P. ANDERSON ; E. KANER ; D. NEWBURY-BIRCH ; J. BRASPENNING ; M. WENSING ; M. HEINEN ; M. LAURANT|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.110, n°12, December 2015)|
|Article en page(s) :||1877-1900|
|Discipline :||PRE (Prévention / Prevention)|
Thésaurus TOXIBASEALCOOL ; INTERVENTION BREVE ; SOINS DE PREMIER RECOURS ; ABUS ; DEPISTAGE ; PRISE EN CHARGE ; REDUCTION DE CONSOMMATION ; EFFICACITE
Background and Aims: Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC.
Methods: Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models.
Results: The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD = 0.07; 95% confidence interval (CI) = -0.02 to 0.16], despite improving screening (SMD = 0.53; 95% CI = 0.28-0.78) and brief intervention delivery (SMD = 0.64;95% CI = 0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P Conclusions: To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.
|Domaine :||Alcool / Alcohol|
|Sous-type de document :||Méta-analyse / Meta-analysis|
|Refs biblio. :||74|
|Affiliation :||Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands|