#PHTwitJC 21: Alcohol Interventions in Primary Care

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The next live Twitter Public Health Journal Club will take place on Wednesday 30th January 2013 at 8pm (GMT)  Thank you to those who voted. The winning paper with 43% of the votes this month is:

E Kaner, M Bland, P Cassidy, S Coulton, V Dale, P Deluca, E Gilvarry, C Godfrey, N Heather, J Myles, D Newbury-Birch, A Oyefeso, S Parrott, K Perryman, T Phillips, J Shepherd and C Drummond (2013) Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial, British Medical Journal, http://www.bmj.com/content/346/bmj.e8501

The Issue – Alcohol

Around 20-30% of patients who routinely present in primary care are hazadous or harmful drinkers.  Brief alcohol intervention in primary care can be helpful, but the optimal intensity of intervention input is unclear.

“Although alcohol has been part of our culture for centuries and many people use it sensibly, its misuse has become a serious and worsening public health problem in the UK. The misuse of alcohol – whether as chronically heavy drinking, binge-drinking or even
moderate drinking in inappropriate circumstances (eg. operating machinery, on medication) – not only poses a threat to the health and wellbeing of the drinker, but also to family, friends, communities and wider society through such problems as crime, anti-social behaviour and loss of productivity. It is also directly linked to a range of health issues such as high blood pressure, mental ill-health, accidental injury, violence,i liver disease and
sexually transmitted infection.” FPH, Alcohol and Public Health

For further information:

The Paper – Summary

This paper aimed to evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care using a pragmatic cluster randomised controlled trial of GP practices in the UK.  Outcomes were measured using the AUDIT (alcohol use disorders identification test) tool at six months, as well as experience of alcohol related problems, health utility, service use and patient motivation to change behaviour.

Brief advice and lifestyle counselling did not provide a statistically significant benefit in reducing hazardous or harmful drinking compared with a patient information leaflet.  Screening followed by simple and written information may be the most appropriate strategy to reduce hazardous and harmful drinking in primary care.

Points for discussion:

  1. Were the aims of the study clearly defined?
  2. Was a randomised-control trial design appropriate to answer this research question?
  3. Were general practices appropriately allocated to intervention and control groups?
  4. Could anything else explain these results? (e.g. chance, bias, confounding, truth)
  5. What are the implications of the study for public health practice?
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