CMAJ. 2014 May 13;186(8):E263-72. doi: 10.1503/cmaj.131301. Epub 2014 Mar 10.
Brief interventions delivered by family physicians to address excessive alcohol use among adult patients are effective. We conducted a study to determine whether such an intervention would be similarly effective in reducing binge drinking and excessive cannabis use among young people.
We conducted a cluster randomized controlled trial involving 33 family physicians in Switzerland. Physicians in the intervention group received training in delivering a brief intervention to young people during the consultation in addition to usual care. Physicians in the control group delivered usual care only. Consecutive patients aged 15-24 years were recruited from each practice and, before the consultation, completed a confidential questionnaire about their general health and substance use. Patients were followed up at 3, 6 and 12 months after the consultation. The primary outcome measure was self-reported excessive substance use (≥ 1 episode of binge drinking, or ≥ 1 joint of cannabis per week, or both) in the past 30 days.
Of the 33 participating physicians, 17 were randomly allocated to the intervention group and 16 to the control group. Of the 594 participating patients, 279 (47.0%) identified themselves as binge drinkers or excessive cannabis users, or both, at baseline. Excessive substance use did not differ significantly between patients whose physicians were in the intervention group and those whose physicians were in the control group at any of the follow-up points (odds ratio [OR] and 95% confidence interval [CI] at 3 months: 0.9 [0.6-1.4]; at 6 mo: 1.0 [0.6-1.6]; and at 12 mo: 1.1 [0.7-1.8]). The differences between groups were also nonsignificant after we restricted the analysis to patients who reported excessive substance use at baseline (OR 1.6, 95% CI 0.9-2.8, at 3 mo; OR 1.7, 95% CI 0.9-3.2, at 6 mo; and OR 1.9, 95% CI 0.9-4.0, at 12 mo).
Training family physicians to use a brief intervention to address excessive substance use among young people was not effective in reducing binge drinking and excessive cannabis use in this patient population.
Australian New Zealand Clinical Trials Registry, no. ACTRN12608000432314.
家庭医生提供的简短干预措施可有效解决成年患者过度饮酒问题。我们开展了一项研究，以确定这种干预措施是否同样可有效减少年轻人的狂饮和过度使用大麻。
我们在瑞士开展了一项群组随机对照试验，涉及 33 位家庭医生。干预组的医生在咨询中接受了向年轻人提供简短干预的培训，此外还提供常规护理。对照组的医生仅提供常规护理。从每个诊所招募连续的 15-24 岁患者，并在咨询前完成一份关于他们一般健康状况和物质使用情况的机密问卷。患者在咨询后 3、6 和 12 个月进行随访。主要观察指标为过去 30 天内自我报告的过度物质使用（≥1 次狂饮，或每周≥1 次大麻，或两者兼有）。
在参与的 33 位医生中，有 17 位被随机分配到干预组，16 位分配到对照组。在 594 位参与患者中，有 279 位（47.0%）在基线时自我报告为狂饮者或过度大麻使用者，或两者兼有。在任何随访点，接受干预组医生治疗的患者与接受对照组医生治疗的患者之间的过度物质使用情况均无显著差异（3 个月时的比值比 [OR] 和 95%置信区间 [CI]：0.9 [0.6-1.4]；6 个月时：1.0 [0.6-1.6]；12 个月时：1.1 [0.7-1.8]）。在将分析仅限于基线时报告过度物质使用的患者后，两组之间的差异也无统计学意义（3 个月时的 OR 1.6，95% CI 0.9-2.8；6 个月时的 OR 1.7，95% CI 0.9-3.2；12 个月时的 OR 1.9，95% CI 0.9-4.0）。
培训家庭医生使用简短干预措施来解决年轻人的过度物质使用问题，并不能有效减少该患者群体中的狂饮和过度使用大麻。
澳大利亚新西兰临床试验注册中心，编号 ACTRN12608000432314。
