Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
PLoS One. 2021 Aug 5;16(8):e0255843. doi: 10.1371/journal.pone.0255843. eCollection 2021.
Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption.
A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 11% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels.
Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.
筛查、简短干预和转介治疗（SBIRT）是一项针对高饮酒量饮酒者减少饮酒量的计划。尽管德国的酒精消费水平很高，且由此造成的危害也很大，但只有 2.9%的初级保健（PHC）患者接受过酒精使用筛查。我们开发了一个开放获取的模拟模型，以估计在德国 PHC 环境中提高 SBIRT 实施率对人群水平饮酒量的影响。
根据调查和销售数据，按性别、年龄和教育程度对 2009 年的饮酒者和非饮酒者进行了假设人群模拟。根据筛查覆盖率和其他参数，从该人群中抽取接受 BI 或 RT 的风险饮酒者。该模拟模型运行十年，根据荟萃分析的效应量改变饮酒水平和重度间歇性饮酒（HED）状况。在 2.9%的筛查覆盖率的基线情况下，2009 年至 2018 年期间，2.4%的德国成年人口接受了后续干预。如果每两个 PHC 患者都接受了酒精使用筛查，到十年模拟期结束时，德国成年居民中有 21%将接受 BI 或 RT。在这种情况下，人群水平的酒精消费将比 2018 年低 11%，而 HED 患病率没有任何变化。筛查覆盖率低于 10%的情况没有发现对饮酒水平有明显影响。
在 PHC 环境中大规模实施 SBIRT 可以使德国的酒精消费大幅减少。由于高筛查覆盖率可能只能在长期内实现，因此需要采取其他有效的酒精政策来实现德国短期内减少酒精使用和由此造成的危害。该开放获取模拟模型在其他环境和其他酒精干预措施中有很大的应用潜力。
