Saitz Richard, Palfai Tibor P, Cheng Debbie M, Horton Nicholas J, Freedner Naomi, Dukes Kim, Kraemer Kevin L, Roberts Mark S, Guerriero Rosanne T, Samet Jeffrey H
Boston Medical Center and Boston University, Boston, Massachusetts 02118, USA.
Ann Intern Med. 2007 Feb 6;146(3):167-76. doi: 10.7326/0003-4819-146-3-200702060-00005.
The efficacy of brief intervention in reducing alcohol consumption is well established for selected outpatients but not for medical inpatients.
To determine whether brief intervention improves alcohol outcomes in medical inpatients who were identified by screening as having unhealthy alcohol use.
Randomized, controlled trial.
Medical service of an urban hospital.
341 medical inpatients who were drinking risky amounts of alcohol (defined for eligibility as >14 drinks/wk or > or =5 drinks/occasion for men and >11 drinks/wk or > or =4 drinks/occasion for women and persons > or =66 y); 77% had alcohol dependence as determined by the Composite International Diagnostic Interview Alcohol Module.
A 30-minute session of motivational counseling given by trained counselors during a patient's hospitalization (n = 172) versus usual care (n = 169).
Self-reported primary outcomes were receipt of alcohol assistance (for example, alcohol disorders specialty treatment) by 3 months in dependent drinkers and change in the mean number of drinks per day from enrollment to 12 months in all patients.
The intervention was not significantly associated with receipt of alcohol assistance by 3 months among alcohol-dependent patients (adjusted proportions receiving assistance, 49% for the intervention group and 44% for the control group; intervention-control difference, 5% [95% CI, -8% to 19%]) or with drinks per day at 12 months among all patients (adjusted mean decreases, 1.5 for patients who received the intervention and 3.1 for patients who received usual care; adjusted mean group difference, -1.5 [CI, -3.7 to 0.6]). There was no significant interaction between the intervention and alcohol dependence in statistical models predicting drinks per day (P = 0.24).
Baseline imbalances existed between randomized groups. Patients who received usual care were assessed and advised that they could discuss their drinking with their physicians.
Brief intervention is insufficient for linking medical inpatients with treatment for alcohol dependence and for changing alcohol consumption. Medical inpatients with unhealthy alcohol use require more extensive, tailored alcohol interventions.
简短干预在减少特定门诊患者酒精摄入量方面的疗效已得到充分证实，但在住院患者中尚未得到证实。
确定简短干预是否能改善经筛查确定存在不健康饮酒行为的住院患者的酒精相关结局。
随机对照试验。
城市医院的内科服务部门。
341名饮酒量有风险的住院患者（定义为符合条件的男性每周饮酒超过14杯或每次饮酒超过或等于5杯，女性及66岁及以上人群每周饮酒超过11杯或每次饮酒超过或等于4杯）；根据综合国际诊断访谈酒精模块确定，77%的患者有酒精依赖。
在患者住院期间，由经过培训的咨询师进行30分钟的动机咨询（n = 172），与常规护理（n = 169）进行对比。
自我报告的主要结局是，在3个月时，依赖饮酒者接受酒精相关援助（如酒精障碍专科治疗）的情况，以及所有患者从入组到12个月期间每天饮酒平均杯数的变化。
在酒精依赖患者中，干预措施与3个月时接受酒精相关援助之间无显著关联（接受援助的调整比例，干预组为49%，对照组为44%；干预组与对照组的差异为5% [95% CI，-8%至19%]），在所有患者中，干预措施与12个月时每天饮酒杯数之间也无显著关联（调整后的平均减少量，接受干预的患者为1.5杯，接受常规护理的患者为3.1杯；调整后的平均组间差异为-1.5 [CI，-3.7至0.6]）。在预测每天饮酒杯数的统计模型中，干预措施与酒精依赖之间无显著交互作用（P = 0.24）。
随机分组之间存在基线不平衡。接受常规护理的患者接受了评估，并被告知他们可以与医生讨论饮酒问题。
简短干预不足以让住院患者接受酒精依赖治疗并改变酒精摄入量。有不健康饮酒行为的住院患者需要更广泛、量身定制的酒精干预措施。
