Effectiveness of a Web-based Intervention for Problem Drinkers and Reasons for Dropout: Randomized Controlled Trial
ABSTRACT Online self-help interventions for problem drinkers show promising results, but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined.
The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers, with the hypotheses that e-therapy would (1) reduce weekly alcohol consumption, and (2) improve health status. Reasons for dropout were also systematically investigated.
In an open randomized controlled trial, Dutch-speaking problem drinkers in the general population were randomly assigned (in blocks of 8, according to a computer-generated random list) to the 3-month e-therapy program (n = 78) or the waiting list control group (n = 78). The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received "no-reply" email messages once every 2 weeks. The primary outcome measures were (1) the difference in the score on weekly alcohol consumption, and (2) the proportion of participants drinking under the problem drinking limit. Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up. A dropout questionnaire was sent to anyone who did not complete the 3-month assessment. Reasons for dropout were independently assessed by the first and third author.
Of the 156 individuals who were randomly assigned, 102 (65%) completed assessment at 3 months. In the intention-to-treat analyses, the e-therapy group (n = 78) showed a significantly greater decrease in alcohol consumption than those in the control group (n = 78) at 3 months. The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% confidence interval 15.69-35.80, P < .001). The between-group effect size (pooled SD) was large (d = 1.21). The results also showed that 68% (53/78) of the e-therapy group was drinking less than 15 (females) or 22 (males) units a week, compared with 15% (12/78) in the control group (OR 12.0, number needed to treat 1.9, P < .001). Dropout analysis showed that the main reasons for dropouts (n = 54) were personal reasons unrelated to the e-therapy program, discomfort with the treatment protocol, and satisfaction with the positive results achieved.
E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem. Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts. Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program.
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ABSTRACT: Many believe that eHealth technologies will contribute to the solution of global health issues and to the necessary innovation of healthcare systems. While this may be true, it is important for public administrations, care professionals, researchers, and the general public to be aware that new technologies are likely to present new or uncertain risks along with their great new opportunities. The present paper aims to assess the risks of eHealth technologies for both patient safety and quality of care. A quick-scan of scientific literature was performed as well as an analysis of web-based sources and databases. Outcomes were validated in a focus group setting against expert views of stakeholders from health care, patients’ organizations, industry, academic research, and government. Risks at human, technological or organizational levels appear to be no subject of systematic research. However, they come into view as ‘secondary’ findings in the margin of these studies. Extensive anecdotal evidence of risks is reported at all three levels in web-based sources as well. Recent authoritative reports substantiate these outcomes. Members of the focus group generally recognized the findings and provided valuable, additional information. A realistic approach to the implementation of eHealth interventions is recommended, taking into account potential benefits as well as risks, and using existing risk management tools throughout the life cycle of the intervention.
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ABSTRACT: The aim of this study is to investigate the effects of an Internet-based screening and brief intervention (SBI) site for problematic alcohol and drug use among illicit drug users. Individuals searching for information about alcohol or drugs online who scored over 0 on the Drug Use Disorders Identification Test (DUDIT) and were 15 years or older were recruited for this trial and randomized into one group receiving Internet-based screening and brief intervention via eScreen.se (n=101) or one assessment-only control group (n=101). Both groups were screened at baseline and followed up at 3 and 6 months. The primary outcome measure was the DUDIT-C score and secondary outcome measures were DUDIT, AUDIT-C (Alcohol Use Disorders Identification Test-C) and AUDIT scores. Additional outcomes included the proportion of drug abstainers and those who made a clinically significant change in their alcohol and drug use. Four statistical models of analysis were used to conservatively assess results. A significant decrease in DUDIT-C scores at the 3-month follow-up occurred in both groups. Three out of four statistical models showed a larger decrease in the DUDIT score in the intervention group than in the control group (p=0.006; p=0.046; p=0.001). Two models showed a continued decrease in AUDIT-C and AUDIT scores also at the 6-month follow-up in the intervention group but not in the control group. No additional differences occurred. The results are inconclusive but provide some evidence that SBI sites such as eScreen.se could be effective for short-term reductions of problematic substance use.Drug and alcohol dependence 05/2012; 126(1-2):42-50. DOI:10.1016/j.drugalcdep.2012.04.016
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ABSTRACT: Challenges for global health care are considerable. Increasing healthcare expenditures, ageing, the rise of chronic diseases and the public health threat of infectious diseases give reason to worldwide concern. Many believe eHealth technologies to contribute to the solution of these issues and to the necessary innovation of healthcare systems. Is the widespread trust among public administrations, care professionals, researchers and the general public justified? The present paper aims to assess the risks of eHealth technologies for both patient safety and quality of care. A quick-scan of scientific literature was performed to collect publications on risks associated with the use of eHealth applications in cure and care. Only random clinical trials (RCTs) were included. Data-management issues were excluded. Of 340 identified publications, 17 met the inclusion criteria. Human, technological or organizational risks appear to be no subject of RCTs. But they come into view en marge implementations. As such, the selected studies suggest there is evidence for risks caused by the use of eHealth in healthcare which can negatively affect the quality of care and the safety of patients. A realistic reconsideration of the implementation of eHealth interventions is recommended. The ceHRes roadmap is an evidence-based guideline to systematically avoid or minimize these risks