Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

Wallace, Paul; Struzzo, Pierluigi; Vedova, Roberto Della; Scafuri, Francesca; Tersar, Costanza; Lygidakis, Charilaos; McGregor, Richard; Scafato, Emanuele; Hunter, Rachael; Freemantle, Nick

doi:10.1136/bmjopen-2016-014576

Cited by 16 publications

(19 citation statements)

References 30 publications

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“…PNF interventions are mostly used in young people, but less evidence is available for adults with more harmful drinking patterns. For this reason, the study by Johnson et al [25] recruited 837 problem drinkers (9 5 and G 9 on the Alcohol Use Disorders Identification Test [22] (AUDIT)) from a hospital outpatient setting and compared the PNF group with an AO condition. No significant between-group differences were found.…”

Section: Personalized Normative Feedbackmentioning

confidence: 99%

“…However, no definite conclusions could be reached due to the small sample sizes of those studies. For this reason, Wallace et al [25] recruited 763 adult problem drinkers (≥ 8 on the AUDIT) from primary care during a visit to their GP and randomized them to unguided internet-based BI or to GP-delivered FTF BI. The unguided internet-based BI was significantly more effective (10% reduction) in reducing the number of patients with an AUDIT score ≥ 8, compared to the FTF BI condition (15% increase).…”

Section: Brief Interventionsmentioning

confidence: 99%

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Digital Mental Health for Alcohol and Substance Use Disorders

Boumparis

Schulte

Riper

2019

Curr Treat Options Psych

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Purpose Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016-2019), with a focus on recent RCTs and whether they addressed some of these gaps. Recent findings Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity. Summary Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.

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Section: Personalized Normative Feedbackmentioning

confidence: 99%

Section: Brief Interventionsmentioning

confidence: 99%

Digital Mental Health for Alcohol and Substance Use Disorders

Boumparis

Schulte

Riper

2019

Curr Treat Options Psych

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“…Patient numbers and loss to follow-up for the trial are reported in figure 1 . Further patient demographics can be found in the main trial findings paper 11 .…”

Section: Resultsmentioning

confidence: 99%

“…Cases of hazardous or harmful drinking prevented at 12 months have been calculated using the data from the main paper for the trial using AUDIT-10 data at 12 months. 11 This was converted to cases prevented per 1000 patients by calculating the percentage of patients that are hazardous or harmful drinkers at 12 months in the face-to-face BI, changing this to a rate per 1000 patient years and applying the OR reported in the main clinical paper 11 for 12 months.…”

Section: Methodsmentioning

confidence: 99%

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

et al. 2017

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ObjectivesTo evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI).DesignRandomised 1:1 non-inferiority trial.SettingPractices of 58 general practitioners (GPs) in Italy.ParticipantsOf 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial.InterventionsPatients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access).Primary and secondary outcome measuresThe primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months.ResultsThe average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI −0.007 to 0.011).ConclusionsFacilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking.Trial registration numberNCT01638338; Post-results.

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“…Most internet studies so far have involved hazardous drinkers in student-or general populations (17). Internet-based approaches have shown similar efficacy as face-to-face treatment (18).Webbased advice to reduce drinking among hazardous drinkers has been successfully implemented in PC in a project in Italy (19).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of iCBT added to treatment as usual for alcohol dependent patients in Primary Care: study protocol for a randomized controlled trial.

Hyland

Hammarberg

Hedman‐Lagerlöf

et al. 2019

Preprint

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Introduction Alcohol dependence is a common disorder with a continuum regarding severity. Most alcohol dependent persons have a moderate level of dependence and live under socially orderly conditions. Treatment seeking in this group is low, mainly due to stigma and because treatment options are seen as unappealing. Alcohol is a relevant topic to discuss in many primary care (PC) consultations and PC is less stigmatizing to visit compared to addiction care units for people with alcohol problems. General practitioners (GP) hesitate to engage in treating alcohol problems due to time constraints and lack of knowledge. Screening and brief interventions are effective for high consumers but there are few studies on dependence. Methods This is a two-group, parallel, randomized controlled trial (RCT). The aim is to study whether an Internet based Cognitive Behavioral Treatment (iCBT) when added to treatment as usual (TAU) is more effective than TAU only for alcohol dependence in PC. 260 adults with alcohol dependence will be included. Participants are randomized to iCBT and TAU or TAU only. The primary study outcome is alcohol consumption in grams per week and heavy drinking days. Secondary outcomes include alcohol related problem severity, number of diagnostic criteria for alcohol dependence, depression and anxiety symptoms, health related quality of life and biochemical markers for high consumption and liver pathology. Data will be analyzed using mixed-effect models. Discussion Internet based interventions are attractive to and have been shown to reach people with alcohol problems. Yet there are no studies investigating the efficacy of internet treatment of alcohol dependence in PC. In this study we hypothesize that iCBT when added to TAU will improve treatment outcome for alcohol dependence in PC, compared to TAU only. If effective, iCBT can be distributed to the public to a low cost for a stakeholder and has the opportunity to reduce both short term and long-term public health costs. Trial registration: ISRCTN69957414. Retrospectively registered 07/06/2018. http://www.isrctn.com/ISRCTN69957414

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Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

Cited by 16 publications

References 30 publications

Digital Mental Health for Alcohol and Substance Use Disorders

Digital Mental Health for Alcohol and Substance Use Disorders

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

The efficacy of iCBT added to treatment as usual for alcohol dependent patients in Primary Care: study protocol for a randomized controlled trial.

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