The effectiveness of brief alcohol interventions in primary care settings: A systematic review

Kaner, Eileen F. S., Dickinson, Heather O., Beyer Fiona, Pienaar, Elizabeth, Schlesinger, Carla, Campbell, Fiona, Saunders, John B., Burnand, Bernard and Heather, Nick (2009) The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug and Alcohol Review, 28 3: 301-323. doi:10.1111/j.1465-3362.2009.00071.x


Author Kaner, Eileen F. S.
Dickinson, Heather O.
Beyer Fiona
Pienaar, Elizabeth
Schlesinger, Carla
Campbell, Fiona
Saunders, John B.
Burnand, Bernard
Heather, Nick
Title The effectiveness of brief alcohol interventions in primary care settings: A systematic review
Journal name Drug and Alcohol Review   Check publisher's open access policy
ISSN 0959-5236
1465-3362
Publication date 2009-05-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/j.1465-3362.2009.00071.x
Open Access Status Not yet assessed
Volume 28
Issue 3
Start page 301
End page 323
Total pages 23
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Issues.
Numerous studies have reported that brief interventions delivered in primary care  are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials.

Approach.
A pre-specified search strategy was used to search all relevant electronic databases up to 2006.We also hand-searched the reference lists of key articles and reviews.We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects metaanalyses, subgroup and sensitivity analyses and meta-regression were conducted.

Key Findings.
The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients.At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week-1, 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I2 = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention.There was no significant difference in effect sizes for efficacy and effectiveness trials.

Conclusions.
Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
Keyword Alcohol
Brief intervention
Systematic review
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Thu, 07 Apr 2011, 22:09:07 EST by Sheila Cleary on behalf of Psychiatry - Royal Brisbane and Women's Hospital