Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients

Abstract

Objectives: Brief intervention for excessive alcohol consumption is effective yet not implemented widely. Alcohol misuse is implicated in unsafe sex and sexually transmitted infections and is common in clients of sexual health services. Our aims were to assess feasibility, acceptability and effectiveness of screening and brief intervention for risky alcohol consumption by a nurse in a sexual health clinic. Methods: Patients completed the AUDIT questionnaire on handheld computers. Those scoring >8 on AUDIT were asked to participate in the study and the 3 months' follow-up and were randomised to intervention or control groups. The Drink-less package (based on WHO validated methods) was used to implement the brief intervention by a trained registered nurse. Results: Of 519 (87%) who completed screening, 204 (39%) scored >8 on AUDIT (eligible), 184 agreed to follow-up and 133 completed it. At follow-up, both groups showed significant reductions in AUDIT scores. Mean scores decreased from 13.7 to 11.5 (control group) and 14.0 to 10.7 (intervention group); most (94%) recalled the intervention and 62% reported reducing drinking compared with 47% of controls (p,0.001). The nurse screening and intervention process was reported acceptable by 74% of patients at follow-up and a majority (71%) of staff. Conclusions: Screening and brief intervention in a sexual health clinic for risky alcohol consumption is feasible, acceptable and effective in producing significant reductions in drinking as measured by AUDIT. Both intervention and control groups decreased consumption, suggesting that screening alone is sufficient to influence behaviour. Further study of brief intervention in this setting is appropriate.

Randomized Controlled Trial of Mailed Personalized Feedback for Problem Drinkers in the Emergency Department: The Short‐Term Impact

“…The follow-up survey included the modified AUDIT used at baseline, but as has been conducted previously, the time frame was modified to avoid overlap of the pre-and posttest periods (Lane et al, 2008). Specifically, questions referred to the 6 weeks prior to the survey, rather than usual 12 months.…”

The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)

“…Lane and colleagues compared the effects of brief intervention for risky drinking delivered by a trained nurse in a sexual health clinic in Sydney, Australia, among 184 people. 21 They found a small, non-statistically significant difference in the proportion of people drinking harmfully among those who did and did not receive a brief intervention. Three months after randomisation, 46% of those in the active arm of the trial and 39% in the control arm were drinking excessively according to AUDIT-C (a three-item quantity frequency measure of alcohol consumption derived from the 10-item Alcohol Use identification test).…”

“…16,21 This remains an important level of attrition, and the intervention effect observed in the completers could be a biased estimate of the effect in all participants, especially if the intervention had a different effect in the non-responders, or if the intervention affected the chance of response. However, the response rate was not highly different between the arms, and we perform different sensitivity analyses to see how missing data could have affected the results.…”

“…9 In their study of young people aged 14-17 years who attended a sexual health clinic in Glasgow, UK, and were found to be drinking excessively, Keogh and colleagues reported that 68% accepted the offer of brief intervention and two-thirds of these received it. 11 The only randomised trial of brief intervention for alcohol in a sexual health setting to have been published to date was conducted by Lane and colleagues in 21 Among 133 people who took part in the study and completed a 3-month follow-up interview, there was a non-statistically significant trend towards lower levels of excessive drinking among those in the active arm of the trial.…”

Spreading alcohol brief interventions from health care to non-health care settings: Is it justified?

“…Reasons for being optimistic about the prospects for ABI in this setting are that surveys have repeatedly demonstrated that a high proportion of those attending sexual health clinics are drinking above recommended levels and that people who drink excessively are more likely to be diagnosed with a sexually transmitted infection. There was also evidence from previous research that ABI in sexual health clinics did reduce alcohol consumption (Lane, Proude, Conigrave, de Boer, & Haber, 2008). Yet the results of this large, rigorously conducted, pragmatic, randomised controlled trial failed to show clinically significant reductions in alcohol consumption among excessive drinkers or provide evidence of a cost-effective use of resources.…”