Lock Catherine A, Kaner Eileen, Heather Nick, Doughty Julie, Crawshaw Andrea, McNamee Paul, Purdy Sarah, Pearson Pauline
School of Population and Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
J Adv Nurs. 2006 May;54(4):426-39. doi: 10.1111/j.1365-2648.2006.03836.x.
This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care.
Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care.
A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention.
Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment.
The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.
本文报告了一项关于由护士主导的筛查和简短干预在减少初级卫生保健患者过度饮酒方面的有效性和成本效益的评估。
过度饮酒是社会、经济和健康问题的主要来源。然而，这种饮酒行为对简短的酒精干预有反应。迄今为止，初级卫生保健中的简短干预研究主要集中在由全科医生主导的干预措施上，而关于护士主导的干预措施有效性的证据仅有间接证据。然而，护士在初级保健的健康促进工作中越来越发挥主导作用。
在2000年8月至2003年6月期间进行了一项实用的整群随机对照试验，以评估与标准建议（对照条件）相比简短干预的效果。共有40个全科医疗群组（干预组 = 21个，对照组 = 19个）招募了127名患者（干预组 = 67名，对照组 = 60名）参与试验。通过酒精使用障碍识别测试机会性地识别过度饮酒情况。在基线评估后，患者接受了使用“少饮酒”方案进行的5 - 10分钟简短干预或标准建议（对照条件）。干预后6个月和12个月进行随访。
按群组大小加权的方差分析显示，随访时干预组和对照组患者之间无统计学显著差异。两种情况下的大多数患者在评估和后续测量之间减少了饮酒量。经济分析表明，与标准治疗相比，简短干预在后续卫生服务资源使用方面未导致统计学显著变化。
本试验中评估的简短干预相对于初级卫生保健中护士提供的标准建议没有效果。然而，随着时间的推移，试验的两个组中过度饮酒情况都有所减少。由于护士退出，本试验的效能明显不足。未来的研究应探索护士参与研究试验的障碍，特别是针对酒精问题的研究。需要进行更大规模的试验来评估护士主导的筛查和简短酒精干预在初级保健中的有效性。
