Wallhed Finn Sara, Hammarberg Anders, Andreasson Sven
Department of Public Health Sciences, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Riddargatan 1, Mottagningen för alkohol och hälsa, Riddargatan 1, Stockholm, Sweden.
Department of Clinical Neurosciences, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Riddargatan 1, Mottagningen för alkohol och hälsa, Riddargatan 1, Stockholm, Sweden.
Alcohol Alcohol. 2018 Jul 1;53(4):376-385. doi: 10.1093/alcalc/agx126.
To investigate if treatment for alcohol dependence in primary care is as effective as specialist addiction care.
Randomized controlled non-inferiority trial, between groups parallel design, not blinded. The non-inferiority limit was set to 50 grams of alcohol per week. About 288 adults fulfilling ICD-10 criteria for alcohol dependence were randomized to treatment in primary care (men n = 82, women n = 62) or specialist care (men n = 77, women n = 67). General practitioners at 12 primary care centers received 1-day training in a treatment manual for alcohol dependence. Primary outcome was change in weekly alcohol consumption at 6-months follow-up compared with baseline, as measured with timeline follow back. Secondary outcomes were heavy drinking days, severity of dependence, consequences of drinking, psychological health, quality of life, satisfaction with treatment and biomarkers.
Intention-to-treat analysis (n = 228) was statistically inconclusive, and could not confirm non-inferiority for the primary outcome, since the high end of the confidence interval exceeded 50 grams (estimated mean weekly alcohol consumption was 30 grams higher in primary care compared with specialist care; 95% confidence interval -10.20; 69.72). However, treatment in specialist care was not significantly superior to primary care (P = 0.146). Subanalysis suggests that specialist care was superior to primary care only for patients with high severity of dependence.
Treatment for alcohol dependence in primary care is a promising approach, especially for individuals with low to moderate dependence. This may be a way to broaden the base of treatment for alcohol dependence, reducing the current treatment gap.
探讨初级保健中酒精依赖治疗是否与专科成瘾治疗一样有效。
随机对照非劣效性试验，组间平行设计，非盲法。非劣效性界限设定为每周50克酒精。约288名符合国际疾病分类第10版（ICD - 10）酒精依赖标准的成年人被随机分配到初级保健治疗组（男性n = 82，女性n = 62）或专科治疗组（男性n = 77，女性n = 67）。12个初级保健中心的全科医生接受了为期1天的酒精依赖治疗手册培训。主要结局是随访6个月时每周酒精摄入量相对于基线的变化，采用时间线追溯法测量。次要结局包括重度饮酒天数、依赖严重程度、饮酒后果、心理健康、生活质量、治疗满意度和生物标志物。
意向性分析（n = 228）在统计学上无定论，无法确认主要结局的非劣效性，因为置信区间上限超过50克（初级保健组估计平均每周酒精摄入量比专科治疗组高30克；95%置信区间 - 10.20；69.72）。然而，专科治疗并不显著优于初级保健（P = 0.146）。亚组分析表明，专科治疗仅对依赖严重程度高的患者优于初级保健。
初级保健中酒精依赖治疗是一种有前景的方法，特别是对于低至中度依赖的个体。这可能是拓宽酒精依赖治疗基础、缩小当前治疗差距的一种方式。
