Lecture on efficacy & effectiveness of Brief Interventions for Alcohol problems, given in to the OECD - HEALTH COMMITTEE, 16th Session.PARIS, DECEMBER 9th, 2014
Brief Interventions for alcohol problems. OECD meeting.
1. A
high-‐risk
approach:
screening
and
brief
interven6ons
in
primary
care
Dr
Antoni
Gual
tgual@clinic.cat
POLICY
DISCUSSION:
ADDRESSING
HARMFUL
ALCOHOL
USE.
OECD
-‐
HEALTH
COMMITTEE.
16th
Session.
PARIS,
DECEMBER
9th,
2014
2. Conflicts
of
interest
Interest
Name
of
organisa/on
Current
roles
and
affilia/ons
Addic6ons
Unit,
Psychiatry
Dept,
Neurosciences
Ins6tute,
Hospital
Clinic,
University
of
Barcelona;
IDIBAPS;
RTA;
Vice
President
of
INEBRIA,
President
of
EUFAS
Grants
Lundbeck,
D&A
Pharma,
FP7,
SANCO
Honoraria
Lundbeck,
D&A
Pharma,
Servier,
Lilly,
Abbvie
Advisory
board/
consultant
Lundbeck,
D&A
Pharma,
Socidrogalcohol
(Alcohol
Clinical
Guidelines)
2013
3. Screening
or
early
iden6fica6on?
• Screening:
Strategy
used
in
a
popula6on
to
iden6fy
an
unrecognised
disease
in
individuals
without
signs
or
symptoms.
• Targeted
screening:
Screening
limited
to
selected
popula6on
(because
of
high
risk
or
high
vulnerability)
• Early
iden/fica/on:
Evalua6on
of
pa6ents
in
whom
signs
of
alcohol
playing
a
nega6ve
role
in
a
case
history
are
present
4. The
AUDIT-‐C
1.
How
oaen
do
you
have
a
drink
containing
alcohol?
2.
How
many
standard
drinks
containing
alcohol
do
you
have
on
a
typical
day
when
drinking?
3.
How
oaen
do
you
have
six
or
more
drinks
on
one
occasion
0)
Never
1)
Less
than
monthly
2)
Monthly
3)
Weekly
4)
Daily
or
almost
daily
5. The
AUDIT-‐C
1.
How
oaen
do
you
have
a
drink
containing
alcohol?
2.
How
many
standard
drinks
containing
alcohol
do
you
have
on
a
typical
day
when
drinking?
3.
How
oaen
do
you
have
six
or
more
drinks
on
one
occasion
0)
Never
1)
Less
than
monthly
2)
Monthly
3)
Weekly
4)
Daily
or
almost
daily
Cut
off
point
for
Hazardous
drinking:
• 4
or
more
in
women
• 5
or
more
in
men
6. Prevalence
of
Alcohol
Dependence
(AD)
and
access
to
treatment.
Data
from
the
APC
study
AD
diagnosis
by
GP
Pa6ents
visited
by
the
GP
13,003
Pa6ents
iden6fied
as
alcohol
dependent
5.1%
(663)
Pa/ents
who
received
professional
help
21.8%
(n=145)
• Six
EU
countries
• GPs
interviewed
about
pa6ents
seen
in
a
given
day
• Pa6ents
interviewed
with
standardized
ques6onnaires
when
they
exit
consulta6on
Rehm
J,
et
al.
Ann
Fam
Med.
2014.
In
press.
7. What is a Brief Intervention?
It
usually
consists
of
a
package
involving:
• informa6on
on
drinking
risk
levels,
• the
status
of
the
pa6ent’s
own
drinking
in
rela6on
to
those
levels,
• encouragement
to
cut
down
and
set
a
date
for
doing
so
• and
perhaps
a
few
simple
hints
on
how
cujng
down
might
best
be
achieved
Heather,
N.,
2010
8. What
is
the
evidence
?
1. Do
brief
interven6ons
work?
Efficacy
studies.
2. Do
brief
interven6ons
work
in
the
real
world
of
primary
care?
Effec/veness
trials.
3. Are
they
cost-‐effec6ve?
Cost-‐effec/veness
studies.
4. What
factors
promote
widespread
adop6on
of
brief
interven6ons
into
rou6ne
prac6ce?
Implementa/on
trials.
5. Wider
roll-‐out
work:
Demonstra/on
studies.
O’Donnell
et
al,
2014
9. 1.
Efficacy
studies
• 23
trials
• Best
evidence
for
10-‐15
min
BIs
and
mul6contacts
•
Compared
to
controls:
• Consump6on
decreased
by
3,6
drinks
per
week
from
baseline
• Heavy
drinking
episodes
reduced
by
12%
• 11%
reported
drinking
below
recommended
limits
Jonas
et
al,
2012
10. 2.
Effec6veness
trials
• 24
systema6c
reviews
• Brief
alcohol
interven6ons
are
effec6ve
when
delivered
in
primary
healthcare
• Brief
alcohol
interven6on
equally
effec6ve
across
different
countries
and
different
health
care
systems
• Insuficient
evidence
in
young
and
older
adults
• Op6mum
length,
frequency
and
content
unknown
O’Donnell
et
al,
2013
12. 3.
Cost-‐effec6veness
studies
Cost-‐effec/ve
Highly
cost-‐effec/ve
Cost-‐saving
Bulgaria
Estonia
Romania
Croa6a
Latvia
Lithuania
Hungary
Slovakia
Poland
Czech
Republic
Germany
Italy
Finland
Portugal
Malta
Cyprus
Greece
Spain
France
Austria
Belgium
Ireland
Luxembourg
Sweden
Netherlands
Denmark
United
Kingdom
Agnus
et
al,
2014,
Unpublished
13. 4.
Implementa6on
trials
• Cluster
randomized
factorial
trial
• 120
PHC
prac6ces
in
5
countries
• Objec6ve:
to
test
three
strategies
that
might
increase
implementa6on
of
EIBI
for
excessive
alcohol
consump6on
in
PHC:
– Training
and
support
(Educa/on)
– Financial
incen6ves
(Money)
– E-‐Brief
Interven6on
(Time)
Keurhorst
et
al,
2013
16. Implementa6on
trials
1. Two
hours
of
training
led
to
more
interven6ons
being
delivered.
2. Modest
financial
reimbursement
led
to
more
interven6ons
being
delivered.
Work
op6mally
when
fine-‐tuned
to
country-‐specific
contexts
3. A
combina6on
of
training
and
support
and
financial
reimbursement
led
to
more
interven6ons
being
delivered
than
either
strategy
alone
Anderson
et
al,
2014,
Submired
17. 5.
Demonstra6on
studies:
screening
in
PHC
in
Catalonia
Colom et al, 2014. Data on file
0"
10"
20"
30"
40"
50"
60"
70"
2005" 2006" 2007" 2008" 2009" 2010" 2011"
Lleida""
Tarragona"
Barcelona"
Girona"
Metropolitana"Sud"
Metropolitana"Nord"
Caralunya"central"
Alt"Pirineu"
Terres"de"l'Ebre"
Total"
Health
areas
in
Catalonia
18. • Double
gap:
iden6fica6on
and
treatment
rates
are
very
low
• BIs
efficacy
and
effec6veness
established.
• Implementa6on
is
difficult
• Dissemina6on
is
feasible
Final
remarks
19. A
high-‐risk
approach:
screening
and
brief
interven6ons
in
primary
care
Dr
Antoni
Gual
tgual@clinic.cat
POLICY
DISCUSSION:
ADDRESSING
HARMFUL
ALCOHOL
USE.
OECD
-‐
HEALTH
COMMITTEE.
16th
Session.
PARIS,
DECEMBER
9th,
2014
THANKS
FOR
YOUR
ATTENTION
!!!
