scholarly journals Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomised trial

2020 ◽  
Author(s):  
Nicolas Barticevic ◽  
Fernando Poblete ◽  
Soledad Zuzulich ◽  
Victoria Rodriguez ◽  
Laura Bradshaw
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Usual Care ◽  
Alcohol Use Disorders ◽  
Randomised Trial ◽  
Intervention Group ◽  
Psychosocial Treatment ◽  
Motivational Enhancement Therapy ◽  
Harmful Alcohol ◽  
Use Pattern

Abstract Background : Harmful alcohol use is a leading cause of global disability and death. However increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. Methods : A parallel-group, single-blinded, severity-stratified, randomised clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfil DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomised to each treatment group. The intervention group will receive an adaptation of the Motivational Enhancement Therapy, as manualized in Project MATCH. This treatment consists of four 45-minute sessions provided by a general psychologist with at least three years of primary care experience. The primary outcome is the change from baseline in the Drinks per Drinking Day during the last 90 days, which will be captured using the TimeLine Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analysed according to the group they were allocated, regardless of the treatment actually received. Mean Differences (MD) will be computed for continuous outcomes and Relative Risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. Discussion : This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. Trial registration : ClinicalTrials.gov, NCT04345302, Registered 28 April 2020, https://clinicaltrials.gov/show/NCT04345302

scholarly journals Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomised trial

2020 ◽  
Author(s):  
Nicolas Barticevic ◽  
Fernando Poblete ◽  
Soledad Zuzulich ◽  
Victoria Rodriguez ◽  
Laura Bradshaw
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Usual Care ◽  
Alcohol Use Disorders ◽  
Randomised Trial ◽  
Intervention Group ◽  
Psychosocial Treatment ◽  
Motivational Enhancement Therapy ◽  
Harmful Alcohol ◽  
Use Pattern

Abstract Background : Harmful alcohol use is a leading cause of global disability and death. However increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. Methods : A parallel-group, single-blinded, severity-stratified, randomised clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfil DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomised to each treatment group. The intervention group will receive an adaptation of the Motivational Enhancement Therapy, as manualized in Project MATCH. This treatment consists of four 45-minute sessions provided by a general psychologist with at least three years of primary care experience. The primary outcome is the change from baseline in the Drinks per Drinking Day during the last 90 days, which will be captured using the TimeLine Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analysed according to the group they were allocated, regardless of the treatment actually received. Mean Differences (MD) will be computed for continuous outcomes and Relative Risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. Discussion : This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. Trial registration : ClinicalTrials.gov, NCT04345302, Registered 28 April 2020, https://clinicaltrials.gov/show/NCT04345302

scholarly journals Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicolas A. Barticevic ◽  
Fernando Poblete ◽  
Soledad M. Zuzulich ◽  
Victoria Rodriguez ◽  
Laura Bradshaw
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Usual Care ◽  
Randomized Trial ◽  
Study Protocol ◽  
Alcohol Use Disorders

scholarly journals Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

2017 ◽  
Vol 177 (10) ◽  
pp. 1480 ◽  
Author(s):  
Katherine E. Watkins ◽  
Allison J. Ober ◽  
Karen Lamp ◽  
Mimi Lind ◽  
Claude Setodji ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Collaborative Care ◽  
Alcohol Use Disorders

scholarly journals Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomised trial of the 3D intervention in primary care

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e019845 ◽  
Author(s):  
Katherine Chaplin ◽  
Peter Bower ◽  
Mei-See Man ◽  
Sara T Brookes ◽  
Daisy Gaunt ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
External Validity ◽  
Randomised Trial ◽  
Baseline Data ◽  
Secondary Outcome ◽  
Treatment Burden ◽  
Practice Staff ◽  
Illness Burden ◽  
Cluster Randomised

ObjectivesRecent evidence has highlighted the high prevalence and impact of multimorbidity, but the evidence base for improving management is limited. We have tested a new complex intervention for multimorbidity (the 3D model). The paper describes the baseline characteristics of practices and patients in order to establish the external validity of trial participants. It also explores current ‘usual primary care’ for multimorbidity, against which the 3D intervention was tested.DesignAnalysis of baseline data from patients in a cluster-randomised controlled trial and additional data from practice staff.SettingPrimary care in the UK.ParticipantsPatients with multimorbidity (n=5253) and 154 practice staff.Primary and secondary outcome measuresUsing surveys and routinely available data, we compared the characteristics of participating and non-participating practices and participating and non-participating eligible patients.Baseline questionnaire data from patient participants was used to examine participant illness burden, treatment burden and perceptions of receiving patient-centred care. We obtained data about usual care preintervention from practice staff using questionnaires and a structured pro forma.ResultsParticipating practices were slightly larger, in less deprived areas, and with slightly higher scores for patient satisfaction compared with non-participating practices. Patients with dementia or learning difficulties were likely to be excluded by their general practitioners, but comparison of participants with non-participants identified only minor differences in characteristics, suggesting that the sample was otherwise representative. Patients reported substantial illness burden, and an important minority reported high treatment burden. Although patients reported relatively high levels of satisfaction with care, many reported not having received potentially important components of care.ConclusionThis trial achieved good levels of external validity. Although patients were generally satisfied with primary care services, there was significant room for improvement in important aspects of care for multimorbidity that are targeted by the 3D intervention.Trial registration numberISRCTN06180958; Post-results.

scholarly journals Opportunistic screening for alcohol use disorders in primary care: comparative study

BMJ ◽  
2006 ◽  
Vol 332 (7540) ◽  
pp. 511-517 ◽  
Author(s):  
Simon Coulton ◽  
Colin Drummond ◽  
Darren James ◽  
Christine Godfrey ◽  
J Martin Bland ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Comparative Study ◽  
Alcohol Use Disorders ◽  
Opportunistic Screening

Treatment of Unhealthy Alcohol Use

2019 ◽  
Author(s):  
Stephen R Holt ◽  
David A Fiellin
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Behavioral Therapy ◽  
Primary Care Providers ◽  
Similar Efficacy ◽  
Motivational Enhancement Therapy ◽  
Behavioral Strategies ◽  
Care Providers ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

Medications for Alcohol Use Disorders in a Primary Care Practice-Based Research Network Implementation Study

2014 ◽  
Vol 32 (1) ◽  
pp. 58-66
Author(s):  
Andrea M. Wessell ◽  
Lynne S. Nemeth ◽  
Ruth G. Jenkins ◽  
Steven M. Ornstein ◽  
Peter M. Miller
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Practice ◽  
Alcohol Use Disorders ◽  
Research Network ◽  
Care Practice ◽  
Implementation Study ◽  
Practice Based Research
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