Lenaerts Evelien, Matheï Catharina, Matthys Frieda, Zeeuws Dieter, Pas Leo, Anderson Peter, Aertgeerts Bert
Academic Center for General Practice, Department of Public health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33, blok j, bus 7001, 3000 Leuven, Belgium.
Academic Center for General Practice, Department of Public health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33, blok j, bus 7001, 3000 Leuven, Belgium.
Drug Alcohol Depend. 2014 Feb 1;135:9-21. doi: 10.1016/j.drugalcdep.2013.10.030. Epub 2013 Nov 14.
A chronic care perspective should be adopted in the treatment of patients with alcohol use disorders (AUDs). Initial treatment in a more intense psychiatric care setting should be followed by continuing care. This systematic review aims to identify effective continuing care interventions for patients with AUDs.
Electronic databases were searched up to February 2013 (MEDLINE, EMBASE, CENTRAL, CINAHL and PsycINFO) to identify RCTs studying continuing care interventions for patients with AUDs. Study selection and quality appraisal was done independently by two reviewers. Drinking and treatment engagement outcomes were considered. Relative risks and mean differences were calculated with 95% confidence intervals. A statistical pooling of results was planned.
20 trials out of 15,235 identified studies met the inclusion criteria. Only six were evaluated as methodologically strong enough and included for further analysis. Interventions ranged from telephone calls and nurse follow-up to various forms of individual or couples counseling. Four trials suggested that supplementing usual continuing care with an active intervention empowering the patient, could be beneficial to drinking outcomes. Effect sizes were limited and not consistent across all outcomes. Because of heterogeneity in the interventions and outcome measures, a meta-analysis could not be performed.
For the treatment of a disease with such devastating consequences, it is remarkable how few high quality studies are available. Adding an active intervention to usual continuing care seems to improve treatment outcomes. We propose an integrated care program with different elements from the selected studies and discuss implications for further research.
酒精使用障碍（AUDs）患者的治疗应采用慢性病护理视角。在更强化的精神科护理环境中进行初始治疗后，应进行持续护理。本系统评价旨在确定针对AUDs患者的有效持续护理干预措施。
检索截至2013年2月的电子数据库（MEDLINE、EMBASE、CENTRAL、CINAHL和PsycINFO），以识别研究AUDs患者持续护理干预措施的随机对照试验（RCTs）。由两名评审员独立进行研究选择和质量评估。考虑饮酒和治疗参与结果。计算相对风险和平均差异，并给出95%置信区间。计划对结果进行统计汇总。
在15235项已识别研究中，有20项试验符合纳入标准。只有6项被评估为方法学上足够有力并纳入进一步分析。干预措施包括电话随访、护士随访以及各种形式的个体或夫妻咨询。四项试验表明，在常规持续护理的基础上补充一种赋予患者权力的积极干预措施，可能对饮酒结果有益。效应量有限，且在所有结果中不一致。由于干预措施和结局测量的异质性，无法进行荟萃分析。
对于一种具有如此严重后果的疾病的治疗，高质量研究如此之少，令人瞩目。在常规持续护理中增加积极干预措施似乎可改善治疗结果。我们提出一个综合护理计划，纳入所选研究中的不同要素，并讨论对进一步研究的启示。
