Babor Thomas F, Higgins-Biddle John C, Dauser Deborah, Burleson Joseph A, Zarkin Gary A, Bray Jeremy
Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT 06030-6325, USA.
Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31. doi: 10.1093/alcalc/agl078. Epub 2006 Oct 10.
Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs).
A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months.
Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by > or =1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were 4.16 US dollar per patient using licensed practitioners and 2.82 US dollar using mid-level specialists.
Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.
评估在管理式医疗保健组织（MCO）中，对筛查出有危险饮酒行为阳性的患者进行简短干预的效果和成本。
在五个MCO机构的15个诊所地点进行了一项前后对照的准实验性多地点评估。有危险饮酒行为的患者（N = 1329）接受以下治疗：（i）由持牌从业者进行简短干预；或（ii）由中级专业人员（护士）进行简短干预；或（iii）常规护理（对照条件）。诊所被随机分配到三种研究条件。收集了筛查和简短干预的成本数据。在3个月和12个月时进行了随访访谈。
在3个月的随访中，所有三种研究条件下的参与者饮酒量均显著减少，但两个干预组的下降幅度明显大于对照组。两种干预条件之间没有显著差异。在干预条件下，60%的患者每周饮酒量减少≥1杯，而对照条件下为53%。在生活质量指标上未发现差异。在12个月的随访中，干预组和对照组每周饮酒量的差异减少具有显著性。使用持牌从业者进行干预的平均增量成本为每位患者4.16美元，使用中级专业人员为2.82美元。
在管理式医疗保健组织中实施酒精筛查和简短干预，可使危险饮酒行为有适度的、具有统计学意义的减少。由中级专业人员按照通用方案进行的干预与由持牌从业者进行的干预效果相同，成本约为其三分之二。
