Meta-analysis on the Effectiveness of Alcohol Screening and Brief Interventions for Patients in Emergency Care Settings

Transcription

1 Meta-analysis on the Effectiveness of Alcohol Screening and Brief Interventions for Patients in Emergency Care Settings - Project BISTAIRS (Brief Interventions in the Treatment of Alcohol Use Disorders in Relevant Settings) Schmidt C 1, Schulte B 1, Seo H 1, Kuhn S 1, O`Donnell A 2, Kriston L 3, Verthein U 1, Reimer J 1 1 Centre for Interdisciplinary Addiction Research, Hamburg University 2 Institute of Health & Society, Newcastle University 3 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf

2 Alcohol Screening and Brief Interventions for Patients in Emergency Care Settings

3

4

5

6

7 Aims: Include as many studies as possible ( lumping vs. splitting ) Effect size estimate What moderates the intervention effect?

8 Aims: Include as many studies as possible ( lumping vs. splitting ) Effect size estimate What moderates the intervention effect? Face-to-face contact Intervention length Type of interventionist (external/internal) Intensity of control intervention Study quality (risk of bias)

9 Study inclusion criteria Published between 01/ /2013 (English) Patient with alcohol-related injury and/or intoxication Randomized controlled trial Alcohol consumption outcome Definition of brief intervention: single session 40 min, or multiple (up to 4) session 30 min.

10 Methods - Data extraction and data synthesis: Three outcome measures: 1) Mean quantity 2) Drinks per drinking day/occasion, 3) Number of episodic heavy drinking occasions

11 Methods - Data extraction and data synthesis: Three outcome measures: 1) Mean quantity 2) Drinks per drinking day/occasion, 3) Number of episodic heavy drinking occasions Comparison of gain from baseline scores (Jonas et al 2012) Random effects model with standardized mean differences Missing parameters for effect size calculation imputed from available information (guidance of the Cochrane and Campbell Collaborations), done by two reviewers Generic inverse variance method (DerSimonian & Laird), ReviewManager 5 Moderator analysis: subgroup comparisons (chi²) and meta-regression with SPSS (Field & Gillet 2010)

12

13 Mean Quantity

14 Mean Quantity

15 Drinks per drinking day/occasion

16 Number of binge drinking occasions

17

18

19 Intervention length Mean quantity 12m follow-up

20 Interventionists Mean quantity 12m follow-up

21 Summary Very small positive effects independent of outcomes/ intervention types/lenghts etc. High generalisability (number of studies included)

22 Summary Very small positive effects independent of outcomes/ intervention types/lenghts etc. High generalisability (number of studies included) Limitations Insufficient reporting of effect size measures in primary studies Not all sources of clinical heterogeneity identified Small subgroups for moderator analysis Unclear: effects of assessment reactivity / alcohol-related emergency itself (control group improvements!)

23 Thank you for your attention. Project website:

24 Acknowledgements Partner University of Hamburg (CIAR) Hamburg, Germany University of Newcastle upon Tyne (UNEW) Newcastle, United Kingdom Fundacio Clinic per al la Recera Biomedica (FCRB) Barcelona, Spain (Catalonia) Instituto Superiore Di Santa (ISS) Rome, Italy Generalität de Catalunya (GENCAT) Barcelona, Spain (Catalonia) National Institute of Public Health (NIPH) Prague, Czech Republic Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências (SICAD) Lisbon, Portugal Function Work package leader National field test coordinator Work package leader Work package leader Work package leader National field test coordinator National field test coordinator National field test coordinator National field test coordinator This action was funded from the European Commission Public Health Programme ( )