基层医疗中针对危险饮酒的筛查及超简短干预的有效性：实用整群随机对照试验

Effectiveness of screening and ultra-brief intervention for hazardous drinking in primary care: pragmatic cluster randomised controlled trial.

作者信息

So Ryuhei, Kariyama Kazuya, Oyamada Shunsuke, Matsushita Sachio, Nishimura Hiroki, Tezuka Yukio, Sunami Takashi, Furukawa Toshi A, Sahker Ethan, Kawaguchi Mitsuhiko, Kobashi Haruhiko, Nishina Sohji, Otsuka Yuki, Kanda Hideyuki, Tsujimoto Yasushi, Horie Yoshinori, Yoshiji Hitoshi, Yuzuriha Takefumi, Nouso Kazuhiro

机构信息

CureApp, Tokyo, Japan

Okayama Psychiatric Medical Centre, Okayama, Japan.

出版信息

BMJ. 2025 Aug 12;390:e083985. doi: 10.1136/bmj-2024-083985.

DOI:10.1136/bmj-2024-083985

PMID:40796231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12340667/

Abstract

OBJECTIVE

To evaluate the effectiveness of a doctor delivered screening and ultra-brief intervention (<1 minute) compared with simplified assessment only for reducing alcohol intake among patients with hazardous drinking in primary care.

DESIGN

Pragmatic cluster randomised controlled trial.

SETTING

40 primary care clinics in Japan that did not provide routine screening and brief intervention for hazardous drinking or treatment or self-help groups for alcohol dependency.

PARTICIPANTS

1133 outpatients aged 20-74 years with hazardous drinking (AUDIT-C (alcohol use disorders identification test-consumption) scores ≥5 for men and ≥4 for women). Clinic clusters were allocated to a study arm using a computer generated random sequence. Participants and staff who collected participant reported outcomes remained blinded to assignment.

INTERVENTIONS

Primary care clinics were randomised to ultra-brief intervention (21 clinics, 531 patients) or simplified assessment only (19 clinics, 602 patients) groups. The intervention group comprised screening with AUDIT-C followed by brief oral advice and an alcohol information leaflet delivered in <1 minute. The control group comprised simplified assessment with AUDIT-C only.

MAIN OUTCOME MEASURES

The primary outcome was total alcohol consumption in the four weeks preceding the 24 week follow-up. Secondary outcomes included total alcohol consumption in the four weeks preceding the 12 week follow-up, and readiness to change drinking behaviour, measured at 12 and 24 weeks.

RESULTS

At 24 weeks, the difference in total alcohol consumption between the ultra-brief intervention group (1046.9 g/4 weeks (g/4wk), 95% confidence interval (CI) 918.3 to 1175.4) and control group (1019.0 g/4wk, 893.5 to 1144.6) was 27.8 g/4wk (-149.7 to 205.4, P=0.75), with a Hedges' g of 0.02 (95% CI -0.10 to 0.14). At 12 weeks, the difference in total alcohol consumption between the intervention group (1034.1 g/4wk, 919.6 to 1148.7) and control group (979.3 g/4wk, 866.1 to 1092.4) was 54.9 g/4wk (-104.1 to 213.9, P=0.49), with a Hedges' g of 0.04 (-0.08 to 0.16).

CONCLUSION

This trial found no evidence to support the effectiveness of a doctor delivered ultra-brief intervention for hazardous drinking compared with simplified assessment only in primary care in Japan.

TRIAL REGISTRATION

UMIN Clinical Trials Registry UMIN000051388.

摘要

目的

评估由医生进行的筛查及超简短干预（<1分钟）与仅进行简化评估相比，在减少初级保健中危险饮酒患者酒精摄入量方面的有效性。

设计

实用整群随机对照试验。

设置

日本40家未提供针对危险饮酒的常规筛查和简短干预、酒精依赖治疗或自助小组的初级保健诊所。

参与者

1133名年龄在20 - 74岁之间的危险饮酒门诊患者（男性酒精使用障碍识别测试 - 消费量（AUDIT - C）得分≥5，女性≥4）。诊所群组使用计算机生成的随机序列分配到研究组。收集参与者报告结局的参与者和工作人员对分配情况保持盲态。

干预措施

初级保健诊所被随机分为超简短干预组（21家诊所，531名患者）或仅简化评估组（19家诊所，602名患者）。干预组包括使用AUDIT - C进行筛查，随后在<1分钟内提供简短口头建议和一份酒精信息传单。对照组仅包括使用AUDIT - C进行简化评估。

主要结局指标

主要结局是24周随访前四周的总酒精消费量。次要结局包括12周随访前四周的总酒精消费量，以及在12周和24周时测量的改变饮酒行为的意愿。

结果

在24周时，超简短干预组（1046.9克/4周（g/4wk），95%置信区间（CI）918.3至1175.4）和对照组（1019.0 g/4wk，893.5至1144.6）之间的总酒精消费量差异为27.8 g/4wk（-149.7至205.4，P = 0.75），Hedges' g为0.02（95% CI -0.10至0.14）。在12周时，干预组（1034.1 g/4wk，919.6至1148.7）和对照组（979.3 g/4wk，866.1至1092.4）之间的总酒精消费量差异为54.9 g/4wk（-104.1至213.9，P = 0.49），Hedges' g为0.04（-0.08至0.16）。