Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Abstract

BackgroundMany primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.MethodsThirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.ResultsIn the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months.ConclusionsRecruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.Trial registrationCurrent Controlled Trials ISRCTN89156543; registered 21 October 2013.

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

“…That lower cut-offs may be inappropriate is also illustrated by the lower effect sizes found in an updated Cochrane review, where the average baseline consumption at enrolment had dropped to 183g/week 60 . It has also been suggested that PHC providers might be more engaged in screening and giving brief advice, if screening were targeted to patients with comorbid conditions, such as depression or hypertension 30 , 61 , 62 . However, to date, there is insufficient evidence for an appropriate package that deals with comorbidity to scale-up 63 .…”

A cross sectional study of alcohol consumption among tribals and non-tribals adults of Narayanganj block in Mandla district of Madhya Pradesh, India

“…10 Wilson et al studied the AUDIT scores in Hypertensive patients. 11 Alcohol consumption in any form is Increasing in rural as well as in tribal pockets of the country, also the lack of awareness about the hazardous effects of its consumption makes the situation grim & alarming therefore we opted for this study to explore the magnitude of the problem not only in rural non-tribal but also in tribal people of this backward tribal district of Madhya Pradesh-Mandla.…”

Implementing primary health care-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasi-experimental study (SCALA study)

“…We set the same cut-offs for men and women, based on epidemiological evidence [85], and to minimize unintended consequences of using different cut offs for men and women [86]. We recognize the importance of comorbid depression [87,88] by building in identification, management, and referral mechanisms [89,90];…”