AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care

Watson, Judith; Crosby, Helen; Dale, VM; Tober, Gillian; Wu, Qing; Lang, Jason M.; McGovern, Ruth; Newbury‐Birch, Dorothy; Parrott, Steve; Bland, J. M.; Drummond, Colin; Godfrey, C.; Kaner, Eileen; Coulton, Simon

doi:10.3310/hta17250

Cited by 37 publications

(49 citation statements)

References 41 publications

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“…The implementation strategies mentioned above were used alone or in combination for managing specific MHP in the elderly population such as major depression, minor or sub‐threshold depression, depression and anxiety in residential care homes, suicidal ideation, alcohol abuse, behavioural symptoms in Alzheimer, and mental problems in specific patient groups …”

Section: Resultsmentioning

confidence: 99%

Improving mental healthcare for the elderly in Belgium

Adriaenssens

Benahmed

Ricour

2019

Health Planning & Management

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Summary Introduction The organisation of mental healthcare for the elderly (MHCE) remains suboptimal. Objective To identify specific organisational models that could address the mental healthcare needs of the elderly in community and primary care. Method A multi‐modal approach, consisting of a literature review, an online survey of Belgian professional stakeholders, and an international comparison. The outcomes of this three‐step study process were aggregated. Results Two general and four operational strategies for organising MHCE were identified as well as barriers and incentives to MHCE in the community and primary care. About half of survey respondents perceived the current MHCE in Belgium not to meet quality criteria as described in the literature and proposed points of improvement. The transversal international comparison revealed interesting approaches for MHCE. Recommendations for the future were formulated. Conclusion MHCE requires a specific, low‐threshold, holistic, and transdisciplinary approach. Specific strategies with emphasis on collaborative care should be applied to meet the needs of older adults with mental problems. General practitioners (GPs) can play a central role in community‐oriented MHCE but should be supported by specialised healthcare providers (including old‐age psychiatrists and geriatricians). Stigma and wrong beliefs, regarding the elderly population, should be tackled by means of campaigns.

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Section: Resultsmentioning

confidence: 99%

Improving mental healthcare for the elderly in Belgium

Adriaenssens

Benahmed

Ricour

2019

Health Planning & Management

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“…Trials were excluded from current analysis for the following reasons: outcome measures at 12‐month follow‐up were reported for the intervention group but were not included as an outcome for the control group ; outcome measures were reported at 30‐ and 60‐day follow‐up ; outcomes measures were reported at 2‐year follow‐up ; the trial was conducted with a special population comprising older adults (65+ years) ; the trial was carried out with a special population consisting of diabetes and/or hypertension patients ; corresponding standard deviation or any useable standard outcomes were not reported . For the PHC setting, 20 trials with a total of 8226 participants (European = 4564/non‐European = 3662) were identified as eligible and included in the meta‐analysis (Supporting information, Table S2 for characteristics of PHC studies).…”

Section: Resultsmentioning

confidence: 99%

A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non‐European countries: a systematic review and meta‐analysis of randomized controlled trials

2015

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“…that addressed the effect of a counseling intervention on alcohol use. Two of the trials targeted adolescents, 92,109 22 targeted collegeaged or young adults, 7 1,7 5,7 9,8 3,87,9 6,9 8 -1 01,1 03 -1 0 5,1 07,1 0 8, 1 1 1 -1 1 3 ,1 2 5 ,1 2 9 ,1 3 3 2 9 a d d r e s s e d g e n e ra l a d u l t p o p u l ations, 70 123,129,133,136 and the remaining were fair quality. Nineteen trials (28%) were included in the previous review.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

O’Connor

Perdue

Senger

et al. 2018

JAMA

170

220

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IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018.STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use.DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTSOne hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, −1.6 [95% CI, −2.2 to −1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful.CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.Additionally, for the outcome drinks per week, whic...

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AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care

Cited by 37 publications

References 41 publications

Improving mental healthcare for the elderly in Belgium

Improving mental healthcare for the elderly in Belgium

A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non‐European countries: a systematic review and meta‐analysis of randomized controlled trials

Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

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