Kaner E F S, Beyer F, Dickinson H O, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B
University of Newcastle upon Tyne, Primary Health Care/Centre for Health Services Research, 21 Claremont Place, Newcastle upon Tyne, UK, NE2 4AA.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD004148. doi: 10.1002/14651858.CD004148.pub3.
Many trials reported that brief interventions are effective in reducing excessive drinking. However, some trials have been criticised for being clinically unrepresentative and unable to inform clinical practice.
To assess the effectiveness of brief intervention, delivered in general practice or based primary care, to reduce alcohol consumption
We searched the Cochrane Drug and Alcohol Group specialised register (February 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), CINAHL (1982 to February 2006), PsycINFO (1840 to February 2006), Science Citation Index (1970 to February 2006), Social Science Citation Index (1970 to February 2006), Alcohol and Alcohol Problems Science Database (1972 to 2003), reference lists of articles.
Randomised controlled trials, patients presenting to primary care not specifically for alcohol treatment; brief intervention of up to four sessions.
Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, sub-group, sensitivity analyses, and meta-regression were conducted.
The meta-analysis included 21 RCTs (7,286 participants), showing that participants receiving brief intervention reduced their alcohol consumption compared to the control group (mean difference: -41 grams/week, 95% CI: -57 to -25), although there was substantial heterogeneity between trials (I2 = 52%). Sub-group analysis (8 studies, 2307 participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Meta-regression showed a non-significant trend of an increased reduction in alcohol consumption of 1.1, 95%CI: -0.05 to 2.2 grams/week, p=0.06, for each extra minute of treatment exposure, but no relationship between the reduction in alcohol consumption and the efficacy score of the trial. Extended intervention when compared with brief intervention was associated with a non-significantly greater reduction in alcohol consumption (mean difference = -28, 95%CI: -62 to 6 grams/week, I2 = 0%)
AUTHORS' CONCLUSIONS: Brief interventions consistently produced reductions in alcohol consumption. When data were available by gender, the effect was clear in men at one year of follow up, but unproven in women. Longer duration of counselling probably has little additional effect. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature had clear relevance to routine primary care. Future trials should focus on women and on delineating the most effective components of interventions.
许多试验报告称，简短干预在减少过度饮酒方面是有效的。然而，一些试验因缺乏临床代表性且无法为临床实践提供参考而受到批评。
评估在全科医疗或基层医疗中进行简短干预以减少酒精摄入量的有效性。
我们检索了Cochrane药物与酒精研究组专业注册库（2006年2月）、MEDLINE（1966年至2006年2月）、EMBASE（1980年至2006年2月）、CINAHL（1982年至2006年2月）、PsycINFO（1840年至2006年2月）、科学引文索引（1970年至2006年2月）、社会科学引文索引（1970年至2006年2月）、酒精与酒精问题科学数据库（1972年至2003年）以及文章的参考文献列表。
随机对照试验，就诊于基层医疗且并非专门为酒精治疗而来的患者；最多四次疗程的简短干预。
两位作者独立提取数据并评估试验质量。进行了随机效应荟萃分析、亚组分析、敏感性分析和荟萃回归分析。
荟萃分析纳入了21项随机对照试验（7286名参与者），结果显示，与对照组相比，接受简短干预的参与者减少了酒精摄入量（平均差值：-41克/周，95%置信区间：-57至-25），尽管试验之间存在较大异质性（I² = 52%）。亚组分析（8项研究，2307名参与者）证实了简短干预对男性有益（平均差值：-57克/周，95%置信区间：-89至-25，I² = 56%），但对女性无明显效果（平均差值：-10克/周，95%置信区间：-48至29，I² = 45%）。荟萃回归分析显示，每增加一分钟的治疗时长，酒精摄入量减少量有增加1.1克/周的趋势，但不显著，95%置信区间：-0.05至2.2克/周，p = 0.06，且酒精摄入量的减少与试验的疗效评分之间无关联。与简短干预相比，延长干预与酒精摄入量的减少幅度无显著更大差异（平均差值 = -28，95%置信区间：-62至6克/周，I² = 0%）
简短干预持续减少了酒精摄入量。按性别分析数据时，随访一年时对男性的效果明显，但对女性未得到证实。更长时间的咨询可能几乎没有额外效果。疗效试验和有效性试验在结果上缺乏差异表明，当前文献与常规基层医疗密切相关。未来的试验应聚焦于女性，并明确干预措施中最有效的组成部分。
