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postgraduate thesis: Physician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review

TitlePhysician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review
Authors
Issue Date2013
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Citation
Chan, C. H. [陳靜嫻]. (2013). Physician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5098348
AbstractBackground: With the increasing public health concern over the alcohol related health burden and mortality globally, the World Health Organization (WHO) has listed alcohol use as the top three risk factors in Non-Communicable Disease (NCD) and the alcohol related mortality and morbidity could be avoided through early intervention and prevention. The Department of Health (DH) of Hong Kong Special Administration Region (HKSAR) has declared the alcohol epidemic was alarming with the increasing in prevalence of alcohol use and binge drinking especially among young people with the westernization of Hong Kong society. In combating local alcohol use epidemic, DH has put priority to reform health care sector system and to ensure that the local health care system is responsive to the local alcohol use problem. Brief intervention (BI) was found to be effective in dealing with at-risk alcohol use especially in primary health care settings in the various past systematic reviews. However, most reviews mainly focus on physician-led BI while the role of nurse in BI delivery in alcohol drinking had not been under great attention. The effectiveness of nurse-led BI to at-risk drinking has not been fully examined as compared with physician-led interventions in the past reviews. Evaluation of treatment components in terms of intensity, treatment components and service settings may also shed light to public health policy makers in development of local model of BI in dealing with drinking problem in the Chinese population. Objective: To investigate the effectiveness of physician-led or nurse-led BI on quantity of alcohol consumption, number of drinking days, number of binge drinking episode and health care utilization. The potentially effective treatment intensity, treatments components and setting of intervention were also investigated. Methods: All the studies published from 1990 to 2012 in MEDLINE, would be evaluated on the effectiveness of BI delivered by physicians and/or nurses to adult at-risk drinkers in primary health care settings, were searched and identified using a combination of keywords. Results: A total of 13 randomized controlled trials out of 134 articles from MEDLINE were included in this systematic review. The included studies used different outcome measurements to compare the effectiveness of BI by physicians and/or nurses in treating at-risk drinking. Similar demographics and clinical characteristics of the subjects between the intervention and control groups were reported. The studies were from 5 countries. The age range of subjects was from 14 to 75 years old. Majority of subjects drank beyond the recommended limits defined by Alcohol Abuse and Alcoholism (NIAA), United State (US). Through there were discrepancies among the results generated in the included studies on the effectiveness of physician-led and/ or nurse-led BI, the benefits of nurse-led BI in treatment of at-risk drinking cannot be dispelled and could be considered as an alternative or supplement to the physician-led BI in busy primary health care setting today. BI with at least two 5-15 minute sessions was found to be more effective than very BI with one 5-minute session only. High quality BI with all five essential treatment components (information giving, advice, goal setting, assistance and follow up) were found to be more effective than partially included treatment. BI were found effective in dealing at risk alcohol use in all General Out Patient Clinic (GOPC) while the effectiveness of BI on alcohol drinking in Special Out Patient Clinic (SOPC) needs further research to warrant the result. Conclusion: Based on this systematic review, the potential effects of nurse-led BI remain unclear in comparison with physician-led BI for at-risk drinkers. More researches on the effectiveness of BI by nurse and its cost-effectiveness as well as BI delivered by different primary health care personnel in treating at-risk alcohol drinking with long study period, especially in the Chinese population, is needed to provide further evidence on the development of local BI in local primary health care settings.
DegreeMaster of Public Health
SubjectDrinking of alcoholic beverages - Health aspects
Dept/ProgramMedicine
Persistent Identifierhttp://hdl.handle.net/10722/193834

 

DC FieldValueLanguage
dc.contributor.authorChan, Ching-han, Helen-
dc.contributor.author陳靜嫻-
dc.date.accessioned2014-01-27T23:10:50Z-
dc.date.available2014-01-27T23:10:50Z-
dc.date.issued2013-
dc.identifier.citationChan, C. H. [陳靜嫻]. (2013). Physician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5098348-
dc.identifier.urihttp://hdl.handle.net/10722/193834-
dc.description.abstractBackground: With the increasing public health concern over the alcohol related health burden and mortality globally, the World Health Organization (WHO) has listed alcohol use as the top three risk factors in Non-Communicable Disease (NCD) and the alcohol related mortality and morbidity could be avoided through early intervention and prevention. The Department of Health (DH) of Hong Kong Special Administration Region (HKSAR) has declared the alcohol epidemic was alarming with the increasing in prevalence of alcohol use and binge drinking especially among young people with the westernization of Hong Kong society. In combating local alcohol use epidemic, DH has put priority to reform health care sector system and to ensure that the local health care system is responsive to the local alcohol use problem. Brief intervention (BI) was found to be effective in dealing with at-risk alcohol use especially in primary health care settings in the various past systematic reviews. However, most reviews mainly focus on physician-led BI while the role of nurse in BI delivery in alcohol drinking had not been under great attention. The effectiveness of nurse-led BI to at-risk drinking has not been fully examined as compared with physician-led interventions in the past reviews. Evaluation of treatment components in terms of intensity, treatment components and service settings may also shed light to public health policy makers in development of local model of BI in dealing with drinking problem in the Chinese population. Objective: To investigate the effectiveness of physician-led or nurse-led BI on quantity of alcohol consumption, number of drinking days, number of binge drinking episode and health care utilization. The potentially effective treatment intensity, treatments components and setting of intervention were also investigated. Methods: All the studies published from 1990 to 2012 in MEDLINE, would be evaluated on the effectiveness of BI delivered by physicians and/or nurses to adult at-risk drinkers in primary health care settings, were searched and identified using a combination of keywords. Results: A total of 13 randomized controlled trials out of 134 articles from MEDLINE were included in this systematic review. The included studies used different outcome measurements to compare the effectiveness of BI by physicians and/or nurses in treating at-risk drinking. Similar demographics and clinical characteristics of the subjects between the intervention and control groups were reported. The studies were from 5 countries. The age range of subjects was from 14 to 75 years old. Majority of subjects drank beyond the recommended limits defined by Alcohol Abuse and Alcoholism (NIAA), United State (US). Through there were discrepancies among the results generated in the included studies on the effectiveness of physician-led and/ or nurse-led BI, the benefits of nurse-led BI in treatment of at-risk drinking cannot be dispelled and could be considered as an alternative or supplement to the physician-led BI in busy primary health care setting today. BI with at least two 5-15 minute sessions was found to be more effective than very BI with one 5-minute session only. High quality BI with all five essential treatment components (information giving, advice, goal setting, assistance and follow up) were found to be more effective than partially included treatment. BI were found effective in dealing at risk alcohol use in all General Out Patient Clinic (GOPC) while the effectiveness of BI on alcohol drinking in Special Out Patient Clinic (SOPC) needs further research to warrant the result. Conclusion: Based on this systematic review, the potential effects of nurse-led BI remain unclear in comparison with physician-led BI for at-risk drinkers. More researches on the effectiveness of BI by nurse and its cost-effectiveness as well as BI delivered by different primary health care personnel in treating at-risk alcohol drinking with long study period, especially in the Chinese population, is needed to provide further evidence on the development of local BI in local primary health care settings.-
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.subject.lcshDrinking of alcoholic beverages - Health aspects-
dc.titlePhysician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review-
dc.typePG_Thesis-
dc.identifier.hkulb5098348-
dc.description.thesisnameMaster of Public Health-
dc.description.thesislevelMaster-
dc.description.thesisdisciplineMedicine-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.5353/th_b5098348-
dc.date.hkucongregation2013-

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