Aperçu: G.M.
La
plupart des patients atteints de troubles liés à l'alcool (AUD) ne
reçoivent jamais de traitement anti-alcool, et les experts ont
recommandé la gestion des AUD dans les soins primaires. Le
choix des options de consommation plus saine dans le cadre du test CarE
primaire (CHOICE), était un essai randomisé d'efficacité contrôlée d'une
nouvelle intervention pour les patients de soins primaires à haut risque
pour les AUD. Ce rapport décrit le fondement conceptuel et scientifique du modèle de
soins CHOICE, éléments critiques de la conception de l'essai CHOICE,
conforme au modèle de description et de réplication d'intervention
(TIDieR), aux résultats du recrutement et aux
caractéristiques de base
de l'échantillon inscrit.
Au total, 304 patients ont consenti à participer au procès CHOICE. Parmi
les participants consentants, 90% étaient des hommes, l'âge moyen était
de 51 (de 22 à 75 ans) et la plupart des critères de DSM-IV pour l'abus
d'alcool (14%) ou la dépendance (59%). Beaucoup
de participants ont également montré des résultats positifs pour
l'usage du tabac (44%), la dépression (45%), les troubles anxieux
(30-41%) et les troubles non-tabagiques (19%).
Bradley KA1,2,3,4, Ludman EJ5, Chavez LJ6,7, Bobb JF5, Ruedebusch SJ8, Achtmeyer CE9, Merrill JO10, Saxon AJ11,12, Caldeiro RM5, Greenberg DM11,12,9, Lee AK5, Richards JE5,13, Thomas RM8, Matson TE5,13, Williams EC8,13, Hawkins E11,8,12, Lapham G5, Kivlahan DR11,8,12.
- 1
- Kaiser
Permanente Washington Health Research Institute, 1730 Minor Ave, Suite
1600, Seattle, WA, 98101-1466, USA. Bradley.K@ghc.org
- 2
- Health
Services Research and Development (HSR&D) Seattle Center of
Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
Bradley.K@ghc.org.
- 3
- Department of Health Services, University of Washington, Seattle, WA, USA. Bradley.K@ghc.org.
- 4
- Department of Medicine, University of Washington, Seattle, WA, USA. Bradley.K@ghc.org.
- 5
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA.
- 6
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA.
- 7
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA.
- 8
- Health
Services Research and Development (HSR&D) Seattle Center of
Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
- 9
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- 10
- Department of Medicine, University of Washington, Seattle, WA, USA.
- 11
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- 12
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
- 13
- Department of Health Services, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND:
Most
patients with alcohol use disorders (AUDs) never receive alcohol
treatment, and experts have recommended management of AUDs in primary
care. The Choosing Healthier Drinking Options In primary CarE (CHOICE)
trial was a randomized controlled effectiveness trial of a novel
intervention for primary care patients at high risk for AUDs. This
report describes the conceptual and scientific foundation of the CHOICE
model of care, critical elements of the CHOICE trial design consistent
with the Template for Intervention Description and Replication (TIDieR),
results of recruitment, and baseline characteristics of the enrolled
sample.
METHODS:
The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based
options for managing AUDs, designed to be practical in primary care.
Outpatients who received care at 3 Veterans Affairs primary care sites
in the Pacific Northwest and reported frequent heavy drinking (≥4
drinks/day for women; ≥5 for men) were recruited (2011-2014) into a
trial in which half of the participants would be offered additional
alcohol-related care from a nurse. CHOICE nurses offered 12 months of
patient-centered care, including proactive outreach and engagement,
repeated brief motivational interventions, monitoring with and without
alcohol biomarkers, medications for AUDs, and/or specialty alcohol
treatment as appropriate and per patient preference. A CHOICE nurse
practitioner was available to prescribe medications for AUDs.
RESULTS:
A
total of 304 patients consented to participate in the CHOICE trial.
Among consenting participants, 90% were men, the mean age was 51 (range
22-75), and most met DSM-IV criteria for alcohol abuse (14%) or
dependence (59%). Many participants also screened positive for tobacco
use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco
drug use disorders (19%). At baseline, participants had a median AUDIT
score of 18 [Interquartile range (IQR) 14-24] and a median readiness to
change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale.
CONCLUSION:
The
CHOICE trial tested a patient-centered intervention for AUDs and
recruited primary care patients at high risk for AUDs, with a spectrum
of severity, co-morbidity, and readiness to change drinking. Trial
registration The trial is registered at clinicaltrial.gov (NCT01400581).
KEYWORDS:
Alcohol
use disorder; Brief interventions; Care management; Chronic Care Model;
Intervention; Medical management; Patient-centered care; Primary care;
Shared decision making; Veterans
