Healthier Drinking Choices A randomised controlled trial of a GP-facilitated web-based intervention for reducing risky alcohol consumption

Transcription

1 Healthier Drinking Choices A randomised controlled trial of a GP-facilitated web-based intervention for reducing risky alcohol consumption Maree Teesson, Nicola Newton, Anthony Shakeshaft, Natasha Nair, Tim Slade, Ann Roche, Alice McEntee, Chris Doran, Michael Tam, Kate Conigrave, Nick Freemantle, Jane Smith, Piero Struzzo, H López-Pelayo & Paul Wallace

2 Acknowledgement of funding CREMS is supported by funding from the National Health and Medical Research Council. NDARC at the University of NSW is supported by funding from the Australian Government MT funded by Principal Research Fellowship, National Health and Medical Research Council. Italian and Spanish Trial support. 2

3 EFAR Australia Trial London School of University of College London Hygiene & Tropical Medicine University of Trieste University Hospital Clinic of Barcelona University of Adelaide Flinders University Bond University University of NSW

4 Why Healthier Drinking Choices in Australia? 4

5 We need a game changer 1/5 Australian adults are risky drinkers (1) o <20% seek help (2) Screening and brief intervention in primary care reduces: o alcohol consumption o alcohol-related injuries o morbidity and mortality o use of healthcare resources (3) Of risky drinkers presenting at GP o <10% are screened o <5% receive brief intervention (4) 1. National Drug Strategy Household Survey, Teesson, Hall, Slade, Mills et al., 2010, Addiction 3. NICE Public Health Programme Report, Anderson et al.,

6 How long before people seek treatment? 18 years Onset 50% by age 20 75% by age Cumulative Probability of Treatment Contact 14 years 23 years 78.1% 27.5% Alcohol Dependence Alcohol Abuse Years Since Onset Abuse Dependence Lifetime treatment rate of AUDs is 34.6% Chapman C, Slade T, Hunt C, Teesson M (2015) Delay to first treatment contact for alcohol use disorder. Drug and Alcohol Dependence 147,

7 Primary Care? First point of contact for people seeking medical advice Primary Care Secondary Care 8

8 Barriers to Implementation Barriers to implementation Lack of training and support Too busy & reluctant to discuss alcohol Lack of resources Advantages of internet No training required Patient completes at home No extra resources required 9

9 Online Interventions in Primary Care N = 117 (smoking, diet, exercise) Alcohol 14% N = 17 Other 10% (emergency dept, uni health centres) *Only 1 RCT *None GP facilitated Nair, et al. (2015). A systematic review of digital and computerbased alcohol intervention programs in primary care. In press. 10

10 Trial Structure Sample: o 60 practices NSW, QLD, SA o 9,538 patients to be approached o 3,434 to complete screener Excluded: o 380 = dependent drinkers ITT sample: o 790 = risky drinkers Online intervention Screener Positive screening GP views results Postintervention interviews Treatment as usual 11

11 Screening Completed in waiting room on: o Tablet (5 per practice) o Mobile (using QR code) Questionnaire: o Demographics, address o AUDIT-C If screened positive (risky drinker): o AUDIT-C 4 (women) or 5 (men) o Baseline questionnaire (TOT-AL, AUDIT, EQ-5D) If screened negative: o On-screen feedback - benefits of sensible drinking 12

12 Randomisation Treatment-as-usual condition: o May include brief face-to-face intervention during consultation Online intervention condition: o GP refers patient to website o Link sent via o Patient completes intervention at home 13

13 Online Intervention Based on Down Your Drink (DYD) website (Wallace et al., 2011) o Trial of 7,935 help-seeking risky drinkers Reduced past week alcohol consumption by 3 month f/u (from 46 to 24 alcohol units) DYD modified to create Healthier Drinking Choices website Adapted for use in Australia 14

14 Online Intervention Patient directed to homepage o Personalised login Three phases: 1. Should I cut down? (Decision Making) 2. Cutting down (Implementing) 3. Staying on track (Relapse Prevention) 15

15 Online Intervention Based on motivational enhancement therapy & computerised CBT Patients can: o Monitor standard drinks o Compare to NHMRC guidelines o Record bingeing episodes & consequences o Set goals o Receive reminders o Make a plan to cope with relapse 16

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18 GP-facilitation and online personalisation Download you doctor Personalised messages: o Welcome video tailored feedback on patient s alcohol consumption o s inviting patient to return to website 19

19 Follow-Up Patients ed to complete online survey at: o 3 months o 6 months Measures o TOT-AL o AUDIT o EQ-5D 20

20 Australian pilot data 2 practices N Excluded (approached) Included (approached, screened positive, gave consent, completed baseline and randomised) Not interested in study 19 Unable to read/comprehend 7 Not computer literate/no 10 Completed screener 21 (33%) Completed baseline (risky drinker) 4 (19%) Randomised 4 Total approached 57 21

21 Full Scale Australian RCT Full scale RCT to begin 2016 o 60 practices NSW, QLD, SA o Approaching around 9,500 patients 22

22 Thank you! Prof. Maree Teesson Director NHMRC Centre of Research Excellence in Mental Health and Substance Use 23