Transcript Related Journal Club Presentation

Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
January–February 2011
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Featured Article
Primary Care-based Intervention
to Reduce At-Risk Drinking
in Older Adults:
A Randomized Controlled Trial
Moore AA, et al. Addiction. 2011;106(1):111–120.
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Study Objective
• To examine whether a multifaceted intervention
among older patients reduced at-risk drinking
and alcohol consumption.
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Study Design
• Randomized controlled trial conducted at 3
primary-care sites in southern California.
• Participants:
– 631 adults aged ≥55 years recruited over 3 years from
participating primary-care provider (PCP) patient
schedules.
– Identified as at-risk drinkers via telephone-administered
Comorbidity Alcohol Risk Evaluation Tool (CARET).*
• Participants received either a booklet on healthy
behaviors (controls) or an intervention.
*Validated measure to identify at-risk drinking in older adults by assessing
amount of alcohol use, comorbid conditions, symptoms, and medications.
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Study Design (cont’d)
• Intervention:
–
–
–
–
–
advice from the primary-care provider.
a personalized report.
a booklet on alcohol and aging.
a drinking diary.
telephone counseling from a health educator at 2, 4, and 8
weeks.
• Primary outcome:
– the proportion of participants meeting at-risk drinking criteria
at 3 and 12 months.
• Secondary outcomes:
– number of drinks in past 7 days.
– heavy drinking (≥4 or more drinks in a day) in the past 7 days.
– CARET score.
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Study Design (cont’d)
• Eligibility criteria:
– age ≥55 years.
– English or Spanish speaker.
– consumed at least 1 alcoholic drink in the past
week.
– able to hear the screening questions.
– healthy enough to participate.
– not treated for an alcohol use disorder in the prior
3 months.
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Assessing Validity of an Article
about Therapy
• Are the results valid?
• What are the results?
• How can I apply the results to patient
care?
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Are the Results Valid?
• Were patients randomized?
• Was randomization concealed?
• Were patients analyzed in the groups to
which they were randomized?
• Were patients in the treatment and control
groups similar with respect to known
prognostic variables?
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Are the Results Valid? (cont‘d)
• Were patients aware of group allocation?
• Were clinicians aware of group allocation?
• Were outcome assessors aware of group
allocation?
• Was follow-up complete?
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Were patients randomized?
• Yes.
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Was randomization concealed?
• Yes.
– Groups were assigned by computer-generated
random numbers.
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Were patients analyzed in the groups
to which they were randomized?
• Yes (intention-to-treat analysis).
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Were the patients in the treatment
and control groups similar?
• Yes.
– Demographic characteristics and reported alcohol
use were similar between the 2 groups at
baseline.
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Were patients aware of group
allocation?
• No.
– Participants were blinded to the true nature of the
study; they were told it focused on healthy
behaviors in older adults, and questions on seatbelt
use, exercise, diet, and smoking were included with
CARET (alcohol screening) questions.
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Were clinicians aware of group
allocation?
• Yes.
– Advice from a primary care physician was a
component of the intervention.
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Were outcome assessors aware of
group allocation?
• No.
– Research assistants blinded to treatment
allocation conducted all baseline and outcome
assessments.
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Was follow-up complete?
• Attrition rates were higher in the intervention
group (n=310):
– 21% at 3 months.
– 29% at 12 months.
than in the control group (n=321):
– 4% at 3 months.
– 7% at 12 months.
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What Are the Results?
• How large was the treatment effect?
• How precise was the estimate of the
treatment effect?
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How large was the treatment effect?
• At 3 months, relative to controls, participants in
the intervention group:
– were less likely to be at-risk drinkers (OR,* 0.41; 95% CI*
0.22–0.75).
– had lower CARET risk scores (RR,* 0.77; 95% CI, 0.63–0.94).
– reported consuming fewer drinks in the past week (RR 0.79;
95% CI, 0.70–0.90).
– reported less past-week heavy drinking (OR 0.46; 95% CI,
0.22–0.99).
• At 12 months, only fewer drinks per week remained
significant (RR, 0.87; 95% CI, 0.76–0.99).
*OR=odds ratio; CI=confidence interval; RR=relative risk.
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How precise was the estimate of
the treatment effect?
• The sample was large, and confidence
intervals were narrow for the observed
effects.
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How Can I Apply the Results to
Patient Care?
• Were the study patients similar to the
patients in my practice?
• Were all clinically important outcomes
considered?
• Are the likely treatment benefits worth
the potential harm and costs?
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Were the study patients similar to
those in my practice?
• Participants ranged in age from 55 to 89 years.
• Seventy-one percent were men, 87% were nonHispanic white, 77% had attended at least
some college, and 75% were either married and
living with someone.
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Were all clinically important
outcomes considered?
• A range of clinically important drinking
outcomes were considered.
• At-risk drinking is associated with a variety of
adverse health consequences. The current
study was neither large enough nor long
enough to assess the impact of the intervention
on outcomes such as mortality, cardiovascular
disease, or breast cancer, all of which are
increased in at-risk drinkers.
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Are the likely treatment benefits
worth the potential harm and costs?
• No harms were identified.
• Cost data were not provided.
• Prior studies have reported favorable costeffectiveness ratios for brief alcohol
interventions.
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