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BMC Health Services Research
Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Study protocol

The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol

Authors: Simon Coulton, Jude Watson, Martin Bland, Colin Drummond, Eileen Kaner, Christine Godfrey, Alan Hassey, Veronica Morton, Steve Parrott, Tom Phillips, Duncan Raistrick, Daphne Rumball, Gillian Tober

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.

Methods/design

The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.

Discussion

The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.

Trial registration

ISRCTN52557360
Appendix
Available only for authorised users
Literature
1.
Academy of Medical Sciences: Calling Time: The Nation's Drinking as a major health Issue. London. 2004
2.
Department of Health: Sensible Drinking. The Report of an Inter-departmental Working Group. 1995, London, Department of Health
3.
Wright F, Whyley C: Accident prevention and risk taking by elderly people: The need for advice. 1994, Age Concern, London
4.
Royal College of Physicians: Alcohol. Can the NHS afford it?. 2002, RCP, London
5.
Thomas V, Rockwood K: Alcohol abuse, cognitive impairment and mortality among older people. Jnl of Am Geriat Soc. 2001, 49: 415-420. 10.1046/j.1532-5415.2001.49085.x.CrossRef
6.
Crome P: What about the elderly?. The international handbook of addiction behaviour. Edited by: Glass I. 1991, Routledge, London
7.
Falaschetti E, Malbut K, Primatesta P: The general health of older people and their use of health resources. Health Survey for England HMSO, London. Edited by: Prior G, Primatesta P. 2002
8.
Woodhouse P, Keating W, Coleshaw S: Factors associated with hypothermia in patients admitted to a group of inner city hospitals. Lancet. 1987, 2: 1201-1205.
9.
Drummond C, Oyefeso A, Phillips T, Cheeta S, Deluca P, Winfield H, Jenner J, Cobain K, Galea S, Saunders V, Perryman K: National Alcohol Research Project: The 2004 national alcohol needs assessment of England. 2005, Department of Health
10.
Coulton S, Drummond C, James D, Godfrey C, Bland JM, Parrott S, Peters T, Stepwice Research Team: Opportunistic screening for alcohol use disorders in primary care: comparative study. British Medical Journal. 2006, 332: 511-7. 10.1136/bmj.38743.421574.7C.CrossRefPubMedPubMedCentral
11.
Callahan C, Tierney W: Health service use and mortality among older primary care patients with alcoholism. J Am Geriatr Soc. 1995, 43 (12): 1378-1383.CrossRefPubMed
12.
Reid M, Anderson P: Geriatric substance use disorders. Med Clin North Am. 1997, 81: 999-10.1016/S0025-7125(05)70560-5.CrossRefPubMed
13.
Cheeta S, Drummond C, Oyefeso A, Phillips T, Deluca P, Perryman K, Coulton S: Low identification of alcohol use disorders in general practice in England. Addiction. 2008, 103: 766-773. 10.1111/j.1360-0443.2008.02198.x.CrossRefPubMed
14.
Tobin C, Aggarwal R, Clarke J, Chown R, King D: Chlamydia trachomatis: opportunistic screening in primary care. Br J Gen Pract. 2001, 51 (468): 565-566.PubMedPubMedCentral
15.
Selzer ML: The Michigan Alcoholism Screening Test (MAST): The quest for a new diagnostic instrument. American Journal of Psychiatry. 1971, 127: 1653-1658.CrossRefPubMed
16.
Patton R, Crawford M, Touquet R: Hazardous drinkers in the accident and emergency department: who accepts advice?. Emergency Medicine Journal. 2004, 21: 491-492. 10.1136/emj.2003.011403.CrossRefPubMedPubMedCentral
17.
Hodgson R, Alwyn T, John B, Thom B, Smith A: The FAST Alcohol Screening Test. Alcohol & Alcoholism. 2002, 37 (1): 61-66. 10.1093/alcalc/37.1.61.CrossRef
18.
Saunders J, Aasland O, Babor T, de la Fuente J, Grant M: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – II. Addiction. 1993, 88: 791-804. 10.1111/j.1360-0443.1993.tb02093.x.CrossRefPubMed
19.
Philpot M, Pearson N, Petratou V, Dayanandan R, Silverman M, Marshall J: Screening for problem drinking in older people: A comparison of CAGE and AUDIT. Aging Ment Health. 2003, 7 (3): 171-175. 10.1080/1360786031000101120.CrossRefPubMed
20.
Crawford M, Patton R, Touquet R, Drummond C, Byford S, Barrett B, Reece B, Brown A, Henry J: Screening and referral for brief intervention of alcohol misusing patients in an Accident and Emergency Department: a pragmatic randomised controlled trial. The Lancet. 2004, 364: 1334-39. 10.1016/S0140-6736(04)17190-0.CrossRef
21.
Wallace P, Cutler S, Haines A: Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. British Medical Journal. 1988, 297: 663-668.CrossRefPubMedPubMedCentral
22.
Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care populations Cochrane Library. 2008, 1.
23.
Bertholet N, Daeppen J-B, Wietlisbach V, Fleming M, Burnand B: Reduction of Alcohol Consumption by Brief Alcohol Intervention in Primary Care. Arch Intern Med. 2005, 165: 986-995. 10.1001/archinte.165.9.986.CrossRefPubMed
24.
Ballesteros J, Duffy JC, Querejeta I, Arino J, Gonzalez-Pinto A: Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Asuncion Alcoholism: Clinical & Experimental Research. 2004, 28: 608-618. 10.1097/01.ALC.0000122106.84718.67.CrossRef
25.
Whitlock EP, Polen MR, Green CA, Orleans T, Klein J: Behavioral counselling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine. 2004, 140: 557-568.CrossRefPubMed
26.
Poikolainen K: Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis. Preventive Medicine. 1999, 28: 503-509. 10.1006/pmed.1999.0467.CrossRefPubMed
27.
Kahan M, Wilson L, Becker L: Effectiveness of physician-based interventions with problem drinkers: a review. Canadian Medical Association Journal. 1995, 152: 851-859.PubMedPubMedCentral
28.
Fleming M, Manwell L, Barry K, Adams W, Stauffacher E: Brieg physician advice for alcohol problems in older adults. Journal of Family Practice. 1999, 48 (5): 378-384.PubMed
29.
Blow F, Barry K: Older patients with at risk and problem drinking patterns: New developments in brief interventions. J Geriatr Psychiatry Neurol. 2000, 13 (3): 115-123.CrossRefPubMed
30.
Curtis J, Geller G, Stokes E: Characteristics, diagnosis and treatment of alcoholism in elderly patients. J Am Geriatr Soc. 1989, 37 (4): 310-316.CrossRefPubMed
31.
Oslin D, Pettinati H, Volpicelli J: Alcoholism treatment adherence. American Journal of Geriatric Psychiatry. 2002, 10: 740-747. 10.1176/appi.ajgp.10.6.740.CrossRefPubMed
32.
Rollnick S, Mason P, Butler C: Health Behaviour Change: A Guide for Practitioners. 1999, Edinburgh: Churchill Livingstone
33.
Project MATCH Research Group Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol. 1997, 58 (1): 7-29.
34.
UKATT Research Team: Effectiveness of treatment for alcohol problems. BMJ. 2005, 331: 541-10.1136/bmj.331.7516.541.CrossRef
35.
Menninger J: Assessment and treatment of alcoholism and substance related disorders in the elderly. Bulletin of the Menninger Clinic. 2002, 66: 166-184. 10.1521/bumc.66.2.166.23364.CrossRefPubMed
36.
Finney J, Moos R, Brennan J: The Drinking Problems Index: An instrument to assess alcohol related problems amongst older adults. Journal of Substance Abuse. 1991, 3: 395-404.CrossRefPubMed
37.
Ware J, Kosinski M, Keller S: A 12-iem short form health survey: Construction of scales and preliminary tests of reliability. Medical Care. 1996, 34: 220-233. 10.1097/00005650-199603000-00003.CrossRefPubMed
38.
The EuroQol Group EuroQol – A new facility for the measurement of health related quality of life. Health Policy. 1990, 16: 199-208. 10.1016/0168-8510(90)90421-9.
39.
UKATT Research Team: Cost-effectiveness of treatment for alcohol problems. BMJ. 2005, 331: 544-10.1136/bmj.331.7516.544.CrossRef
40.
Raistrick D, Godfrey C, Parrott S, Tober G: Costs and cost effectiveness of treatment as usual in drug misuse services. 2004, Leeds: Leeds Addiction Unit
41.
STEPWICE Research Group: The effectiveness and cost-effectiveness of screening and stepped care interventions for alcohol use disorders in the primary care setting. 2003, Welsh Office of Research & Development
42.
Moyer A, Finney JW, Swearingen CE, Vergun P: Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002, 97 (3): 279-292. 10.1046/j.1360-0443.2002.00018.x.CrossRefPubMed
43.
Gordon A, Conigliaro J, Maisto S, McNeil M, Kraemer K, Kelley M: Comparison of consumption effects of brief interventions for hazardous drinking elderly. Substance Use and Misuse. 2003, 38 (8): 1017-1035. 10.1081/JA-120017649.CrossRefPubMed
44.
Lemke S, Moos R: Outcomes at 1 year and 5 years for older patients with alcohol use disorders. Journal of substance abuse treatment. 2003, 24 (1): 43-50. 10.1016/S0740-5472(02)00321-5.CrossRefPubMed
45.
Atkinson R: Treatment programmes for aging alcoholics. Alcohol and aging. Edited by: Beresford T, Gomberg E. 1995, Oxford University Press, New York, 186-210.
46.
Heather N, Rollnick S, Bell A, Richmond R: Effects of brief counselling among male heavy drinkers identified on general hospital wards. Drug and Alcohol Review. 1996, 15: 29-38. 10.1080/09595239600185641.CrossRefPubMed
47.
National Institute for Health and Clinical Excellence Methods for technology appraisals. 2004, London: NICE
48.
National Institute for Health and Clinical Excellence Guidance for the evaluation of public health interventions. 2006, London: NICE
49.
Curtis L, (ed): Unit costs of healthy and social care. 2007, PSSRU, University of Kent
50.
Richardson G, Manca A: Calculation of quality adjusted life years in the published literature: a review of methodology and transparency. Health Economics. 2004, 13 (12): 1203-1210. 10.1002/hec.901.CrossRefPubMed
51.
Fenwick E, Claxton K, Sculpher M: Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Economics. 2001, 10: 779-787. 10.1002/hec.635.CrossRefPubMed
Metadata
Title
The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol
Authors
Simon Coulton
Jude Watson
Martin Bland
Colin Drummond
Eileen Kaner
Christine Godfrey
Alan Hassey
Veronica Morton
Steve Parrott
Tom Phillips
Duncan Raistrick
Daphne Rumball
Gillian Tober
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-129

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