Dataset Information

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial.

ABSTRACT: Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)-prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines-were moderated by patients' sex. Patients (n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies.

SUBMITTER: Minian N

PROVIDER: S-EPMC7037372 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial.

Minian Nadia N Ivanova Anna A Voci Sabrina S Veldhuizen Scott S Zawertailo Laurie L Baliunas Dolly D Noormohamed Aliya A Giesbrecht Norman N Selby Peter P

International journal of environmental research and public health 20200206 3

Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)-prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines-were moderated ...[more]

PMID: 32041190

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Project description:BackgroundResearch estimates that 30% of children under the age of 16 years in the UK live with at least one parent with an alcohol use disorder (AUD). Parental AUDs are associated with adverse childhood experiences and poorer outcomes for children. The PAReNTS (Promoting Alcohol Reduction in Non-Treatment Seeking parents) trial aims to examine the feasibility and acceptability of a randomised controlled trial of brief alcohol interventions to reduce parental alcohol misuse.MethodsThe cluster randomised controlled trial will be conducted within early help family support and children's social care services in three local authorities in the North East of England: Newcastle, Durham and North Tyneside. All eligible parents the caseloads of participating practitioners will be screened for an AUD using the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) screening tool by the social care practitioners within routine appointments. All parents who score 5 or more on the AUDIT-C will be invited to participate in the trial. Consenting participants will complete a baseline questionnaire before receiving one of three randomised interventions: (i) healthy lifestyle leaflet (control intervention); (ii) a brief alcohol advice intervention delivered by the social care practitioner plus healthy lifestyle leaflet; (iii) a brief alcohol advice intervention delivered by the social care practitioner, healthy lifestyle leaflet plus a 40-min behaviour change intervention with an optional review session delivered by the local alcohol service. Follow-up data will be collected 6 and 12 months post recruitment. A linked qualitative study will explore participating parent and practitioner views on the acceptability of trial processes and interventions.DiscussionThe PAReNTS trial will provide a robust estimate of recruitment, retention and consent rates in order to inform the design of a future definitive study examining the effectiveness and cost-effectiveness of alcohol screening and brief interventions to reduce parental AUDs within vulnerable families.Trial registrationISRCTN registry ISRCTN60291091; protocol version 2; 17.10.2016.

Project description:BACKGROUND:In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let's Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. OBJECTIVE:We conducted a randomized trial of Let's Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. METHODS:Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. RESULTS:Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let's Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let's Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=-0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. CONCLUSIONS:The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. TRIAL REGISTRATION:ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162.

Project description:BackgroundClinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt.MethodsThis was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method.ResultsTwo hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88-1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71-1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01-2.16, p = 0.045).ConclusionA CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients' acceptance of the resource.Trial registrationThis trial is registered with ClinicalTrials.gov, number NCT03108144 , registered on April 11, 2017, "retrospectively registered".

Project description:To undertake the first randomized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking.This parallel group randomized trial allocated participants individually to brief alcohol intervention (n?=?205) or a leaflet-only control condition (n?=?202), with follow-up study after 3 months.Sixteen community pharmacies in one London Borough, UK.A total of 407 pharmacy customers (aged 18?years or over) with Alcohol Use Disorder Identification Test (AUDIT) scores 8-19, inclusive.A brief motivational discussion of approximately 10 minutes' duration, for which 17 pharmacists received a half-day of training.Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a researcher blind to allocation status. The two primary outcomes were: (1) change in AUDIT total scores and (2) the proportions no longer hazardous or harmful drinkers (scoring <?8) at 3?months. The four secondary outcomes were: the three subscale scores of the AUDIT (for consumption, problems and dependence) and health status according to the EQ-5D (a standardized instrument for use as a measure of health outcome).At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed-up. The difference in reduction in total AUDIT score (intervention minus control) was -0.57, 95% confidence interval (CI)?=?-1.59 to 0.45, P?=?0.28. The odds ratio for AUDIT ??8 (control as reference) was 0.87, 95% CI?=?0.50 to 1.51, P?=?0.61). For two of the four secondary outcomes (dependence score: -0.46, 95% CI?=?-0.82 to -0.09, P?=?0.014; health status score: -0.09, 95% CI?=?-0.16 to -0.02, P?=?0.013) the control group did better, and in the other two there were no differences (consumption score: -0.05, 95% CI?=?-0.54 to 0.44, P?=?0.85; non-dependence problems score: -0.13, 95% CI?=?-0.66 to 0.41). Sensitivity analyses did not change these findings.A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.

Dataset Information

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial.

Publications

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial.

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