Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care‐based multi‐component brief intervention to reduce risky drug use

Abstract

Aims To assess the effect of a multi-component primary care (PC)-delivered BI for reducing risky drug use (RDU) among patients identified by screening. Design Multicenter single-blind two-arm randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3-month follow-up. Randomization and allocation to trial group were computer-generated. Setting Primary care waiting rooms of 5 federally qualified health centers (FQHCs) in Los Angeles County (LAC), USA. Participants 334 adult primary care patients (171 intervention; 163 control) with RDU scores (4–26) on the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) self-administered on tablet PCs; 261 (78%) completed follow-up. Mean age was 41.7 years; 63% were male; 38% were Caucasian. Intervention(s) and Measurement Intervention patients received brief (typically 3–4 minutes) clinician advice to quit/reduce their drug use reinforced by a video doctor message, health education booklet, and up to two 20–30 minute follow-up telephone drug use coaching sessions. Controls received usual care and cancer screening information. Primary outcome was patient self-reported use of highest scoring drug (HSD) at follow-up. Findings Intervention and control patients reported equivalent baseline HSD use; at follow-up, after adjustment for covariates in a linear regression model, intervention patients reported using their HSD an average of 2.21 fewer days in the previous month than controls (p<0.005). No compensatory increases in use of other measured substances were found (p>0.10). Conclusions A clinician-delivered brief intervention with follow-up counseling calls may decrease drug use among risky users compared with usual care in low-income community health centers of Los Angeles County, USA.

A pilot replication of QUIT, a randomized controlled trial of a brief intervention for reducing risky drug use, among Latino primary care patients

“…Patients self-administered all questionnaires on “talking touch-screen” tablet computers (Gelberg et al, 2015; Hahn et al, 2004; Hahn et al, 2011; Karlsson and Bendtsen, 2005; Singleton et al, 2011). The CONSORT diagram for enrollment is shown in Figure 1.…”

“…As previously described (Gelberg et al, 2015), lay health educators (HEs) were trained in motivational interviewing (Miller and Rollnick, 2002) and cognitive behavioral techniques. Weekly meetings with the PIs and project director fostered a HE “Learning Community,” where every case was discussed to maintain fidelity to the protocol.…”

“…QUIT is the only primary care-based brief intervention that has previously shown efficacy for reducing risky drug use in the US (Gelberg et al, 2015). This pilot study replicated the QUIT protocol in one of the five original QUIT clinics primarily serving Latinos.…”

“…The Quit Using Drugs Intervention Trial (QUIT) is the only primary care-based brief intervention protocol that has shown efficacy for reducing risky drug use among adults in the US (Gelberg et al, 2015; Padwa et al, 2014). The 9th US-Mexico Binational Conference on Drug Demand Reduction held in 2011 recommended a pilot comparative randomized controlled trial of the efficacy of screening for drug use and brief intervention for drug users in community health centers in the US-Mexico border regions (Office of National Drug Control Policy, 2011), and funded a randomized controlled trial, the “US-Mexico Binational QUIT Study.” Here we report on a pilot replication of QUIT in the US, in one of the original QUIT study sites at a later time period (1 year later), testing the efficacy of the brief intervention protocol in reducing risky drug use in mostly Latino patients (the now “majority minority” in Los Angeles) (U.S.…”

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Background QUIT is the only primary care-based brief intervention that has previously shown efficacy for reducing risky drug use in the US (Gelberg et al, 2015). This pilot study replicated the QUIT protocol in one of the five original QUIT clinics primarily serving Latinos.

Design

Single-blind, two-arm, randomized controlled trial of patients enrolled from March–October 2013 with 3-month follow-up.

Setting

Primary care waiting room of a federally qualified health center (FQHC) in East Los Angeles.

Participants

Adult patients with risky drug use (4–26 on the computerized WHO ASSIST): 65 patients (32 intervention, 33 control); 51 (78%) completed follow-up; mean age 30.8 years; 59% male; 94% Latino.

Interventions and measures

Intervention patients received: 1) brief (typically 3–4 minutes) clinician advice to quit/reduce their risky drug use, 2) video doctor message reinforcing the clinician’s advice, 3) health education booklet, and 4) up to two 20–30 minute follow-up telephone drug use reduction coaching sessions.

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