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

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 ($$\chi 2$$ χ 2 [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://clinicaltrials.gov/ct2/show/NCT02642757.

Comparative effectiveness of psychosocial interventions in adults with harmful use of alcohol: a systematic review and network meta‐analysis

“…The average age of participants was 35.68 years (average age ranged from 18.99 to 62.83 years), and 67% ( n = 4790) of participants were male. Of the 19 RCTs included in this systematic review, 17 studies used AUDIT as an outcome (and were included in the primary analysis) [37–41, 43–52, 54, 55], while two used the AUDIT‐C (and were added to the secondary analysis) [42, 53]. Three studies (Hansson et al ., Safsten et al ., Xiaolu et al .)…”

Effectiveness of a health technician-delivered brief intervention for alcohol: a Bayesian reanalysis of a clinical trial

“…Then, mixed-effects regressions were used to adjust for demographic variables as fixed-effects (age, sex, and educational level) and the health center as random effects. See the main paper for a detailed description of the trial [ 4 ].…”

“…As alcohol BIs are delivered by physicians in high income countries [ 3 ], less is known about BIs’ effectiveness when provided by non-professional health workers. In this context, we conducted a randomized controlled trial (RCT) to inform policy makers regarding the potential impact of the national program [ 4 ]. Our main finding was an OR of 0.6 (CI 0.34–1.05) for risk reduction with a p-value of 0.07, from which we concluded that there was no observed effect attributable to the BI, and thus, the program could make better use of resources by not providing one-to-one HT-led interventions.…”

Effectiveness of a Health Technician-delivered Brief Intervention for alcohol A Bayesian reanalysis of a clinical trial

“…Then, mixed-effects regressions were used to adjust for demographic variables as xed-effects (age, sex, and educational level) and the health center as random effects. See the main paper for a detailed description of the trial [4].…”

“…As alcohol BIs are delivered by physicians in high income countries [3], less is known about BIs' effectiveness when provided by non-professional health workers. In this context, we conducted a randomized controlled trial (RCT) to inform policy makers regarding the potential impact of the national program [4]. Our main nding was an OR of 0.6 (CI 0.34-1.05) for risk reduction with a p-value of 0.07, from which we concluded that there was no observed effect attributable to the BI, and thus, the program could make better use of resources by not providing one-to-one HT-led interventions.…”