Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Drug Alcohol Rev. 2009 May;28(3):301-23. doi: 10.1111/j.1465-3362.2009.00071.x.
Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials.
A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted.
The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I(2) = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials.
Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
许多研究报告称，在初级保健中实施简短干预措施可有效减少过度饮酒。然而，这些工作的大部分都因临床代表性不足而受到批评。本综述旨在评估初级保健中简短干预措施的有效性，并确定疗效试验和有效性试验的结果是否存在差异。
采用预先指定的搜索策略，检索了截至 2006 年所有相关电子数据库。我们还手工检索了关键文章和综述的参考文献列表。我们纳入了在初级保健中没有寻求酒精治疗且接受简短干预的患者的随机对照试验（RCT）。两名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、亚组和敏感性分析以及荟萃回归。
主要荟萃分析包括 22 项 RCT，评估了超过 5800 例患者的结局。在 1 年随访时，与对照组相比，接受简短干预的患者饮酒量显著减少[平均差异：-38 g 周(-1)，95%置信区间（CI）：-54 至 -23]，尽管试验间存在很大的异质性（I(2) = 57%）。亚组分析证实了简短干预对男性的益处，但对女性则不然。与简短干预相比，扩展干预与饮酒量减少的非显著增加相关。疗效和有效性试验的效果大小无显著差异。
简短干预可减少男性的饮酒量，干预 1 年后仍有获益，但对女性则无获益，且针对女性的研究数据不足。与简短干预相比，较长时间的咨询没有明显的额外效果。疗效和有效性试验之间在结果上没有差异，表明当前文献与常规初级保健相关。
Zotero 插件