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Randomized Controlled Trial
. 2013 Jan 9:346:e8501.
doi: 10.1136/bmj.e8501.

Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

Eileen Kaner  1 , Martin Bland, Paul Cassidy, Simon Coulton, Veronica Dale, Paolo Deluca, Eilish Gilvarry, Christine Godfrey, Nick Heather, Judy Myles, Dorothy Newbury-Birch, Adenekan Oyefeso, Steve Parrott, Katherine Perryman, Tom Phillips, Jonathan Shepherd, Colin Drummond
Affiliations
Randomized Controlled Trial

Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

Eileen Kaner et al. BMJ. .

Abstract

Objective: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking.

Design: Pragmatic cluster randomised controlled trial.

Setting: Primary care practices in the north east and south east of England and in London.

Participants: 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers.

Interventions: Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation.

Main outcome measures: The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler.

Results: Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings.

Conclusions: All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking.

Trial registration: Current Controlled Trials ISRCTN06145674.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors had financial support from the Department of Health in England (Alcohol Policy Unit) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of participants through trial
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Fig 2 Proportion of patients scoring <8 (negative status) on alcohol use disorders identification test, representing non-hazardous or non-harmful drinking
See this image and copyright information in PMC

Comment in

References

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