Pilot study: Testing an online alcohol intervention in primary care

Size: px

Start display at page:

Download "Pilot study: Testing an online alcohol intervention in primary care"

Bertina Ryan
7 years ago
Views:

1 Pilot study: Testing an online alcohol intervention in primary care Natasha Nair 1,2, Maree Teesson 1,2, Anthony Shakeshaft 1, Nicola Newton 1,2 & Paul Wallace 3 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia 2 Centre for Research Excellence in Mental Health & Substance Use 3 University of College London, London, UK

2 Acknowledgements Research team: UNSW - Teesson, Shakeshaft, Newton, Tam, Zwar UCL Wallace, Hunter, Fremantle Flinders University - Roche, Reed Bond University - Smith University of Adelaide - Delfante RCTPC - Struzzo LSHTM - Araya Funding: NDARC at the University of NSW is supported by funding from the Australian Government. CREMS is supported by funding from the National Health and Medical Research Council.

3 EFAR Australia Trial London School of University of College London University Hospital Clinic of Barcelona Hygiene & Tropical Medicine Regional Centre for Training in Primary Care University of Adelaide Flinders University Bond University University of NSW

4 What is Primary Care? First point of contact for patient seeking medical advice Commonly General Practitioners (GPs) Primary Care (e.g. GP) Secondary Care (e.g. radiologist, surgeon)

5 Why Intervene? 1/5 Australian adults are risky drinkers (1) <20% of risky drinkers seek help (2) Screening and brief intervention (SBI) in primary care reduces: alcohol consumption alcohol-related injuries morbidity and mortality use of healthcare resources (3) Risky drinkers presenting at GP <10% are screened <5% receive brief intervention (4) 1. National Drug Strategy Household Survey, Teesson, Hall, Slade, Mills et al., NICE Public Health Programme Report, Anderson et al., 2009

6 Barriers to Implementation Barriers to implementation Lack of training and support Too busy Lack of resources Advantages of internet No training required Patient completes at home No extra resources required

7 Literature: Online Interventions in Primary Care Other 83% (smoking, diet, exercise) Alcohol 17% Other 15% (emergency dept, uni health centres) *No trials in Australia GP 2% EFAR Australia research team. (2014). Systematic review of online alcohol interventions designed for patients in primary care. In preparation.

8 Pilot Study Setting: 10 practices NSW QLD SA Sample: Up to 20 patients per practice All GPs and staff working at practice Online intervention Screener Positive screening GP views results Postintervention interviews Treatment as usual

9 Screening Online intervention Screener Positive screening GP reviews results Postintervention interviews Screener: Demographics & contact details AUDIT-C Treatment as usual If screened positive: AUDIT-C 5 (men) or 4 (women) Consent Baseline questionnaire (AUDIT & EQ-5D) If screened negative: On-screen feedback - benefits of sensible drinking

10 Randomisation Online intervention Screener Positive screening GP reviews results Postintervention interviews Treatment as usual Treatment-as-usual condition: May include brief face-to-face intervention during consultation Online intervention condition: GP refers to website Link sent via Patient completes at home

11 Online Intervention Based on Down Your Drink website (Wallace et al., 2008) Reduced alcohol consumption & risky drinking behaviour Modified to create:

12 Online Intervention Patient directed to homepage Set up own login Three phases: 1. Should I cut down? (Decision Making) 2. Cutting down (Implementing) 3. Staying on track (Relapse Prevention)

13 Phase 1: Should I cut down? (Decision Making) Based on motivational enhancement therapy Patients can: Record standard drinks consumed Compare to NHMRC guidelines Compare to others of their age and gender Examine consequences of their drinking

14 Phase 2: Cutting down (Implementing) Based on principles of: Computerised cognitive behavioural therapy Behavioural self-control Patients can: Record thoughts and emotions Record bingeing episodes & consequences Record personal alcohol expectations Set goals

15 Phase 3: Keeping on track (Relapse prevention) Based on principles of relapse prevention Patients can: Reflect on goals Receive reminders Records times of relapse Make a plan to cope with relapse

18 Post-intervention Interviews Online intervention Screener Positive screening GP reviews results Postintervention interviews Treatment as usual

19 Post-intervention Interviews Semi-structured interviews - 4 weeks after baseline Patients Experiences with website or TAU Questionnaire: AUDIT & EQ-5D GPs Referrals to website vs. TAU GP staff Recruiting adds extra time? Difficulties managing tablets

20 Where To From Here? Implement pilot study starting in October 2014 Full-scale RCT in practices 800 patients GP personalisation of website

21 Thank you! Natasha Nair Healthier Drinking Choices

Screening and brief intervention for alcohol use in general practice and the potential role of digital technologies in optimising delivery

Presentation to Imperial College London Wednesday 10 th December 2014 Screening and brief intervention for alcohol use in general practice and the potential role of digital technologies in optimising delivery