Technology-Based Alcohol Interventions in Primary Care: Systematic Review

Abstract

Background Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. Objective The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. Methods We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. Results Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. Conclusions Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings.

Psychiatric comorbidities in alcohol use disorder

“…142,143 Interventions delivered through smartphone and other new technologies are feasible and acceptable among patients. 144 To that end, however, integrated treatments for simultaneously addressing alcohol use disorder and other externalising disorders (and internalising disorders) are limited in scope and number, in part because of the complexity of treating two or more concurrent disorders, but also because of our limited understanding of the underlying mechanisms linking alcohol use disorder to other psychiatric disorders. Furthermore, developing the evidence base regarding variation by co-occurring disorders in the effectiveness of treatment of alcohol use disorder is also a necessary area of research, to which the growing databases of electronic and other highvolume data sources will undoubtedly contribute.…”

Integrating patient perspectives in the development of a mobile health intervention to address chronic pain and heavy drinking in primary care: a qualitative study of patients in an urban, safety-net hospital setting

“…In sum, this study provides important qualitative data to help tailor an integrated mobile health intervention for comorbid chronic pain and heavy drinking among primary care patients. In addition to better understanding participants’ perspectives on the content of the proposed intervention, these interviews point to the potential value of using a smartphone-based approach which has been shown to increase the adoption, reach, and efficacy of behavioral health interventions [ 36 ]. The next phase of intervention development will incorporate the themes and participant feedback from this study in advance of testing intervention usability and feasibility in an open pilot trial followed by preliminary testing of efficacy in a pilot randomized controlled trial.…”

Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study

“…Scalable public health interventions are necessary to reduce the impact of tobacco use and risky drinking. Digital health interventions have demonstrated effectiveness for promoting smoking cessation and reducing alcohol use [10][11][12][13][14][15]. The availability of digital health interventions has rapidly increased over the past decade fueled by scientific interest, commercial investment, and public demand for these interventions [16][17][18].They can overcome psychological and logistical barriers (eg, stigma, cost, time) that impede the reach of traditional behavioral interventions (eg, in-person or group counselling).Their demonstrated effectiveness, combined with their scalability to reach large populations at a relatively low incremental cost per user, has the potential to achieve high population health impact [10,19,20].…”