Brief physician advice for problem drinking among older adults: an economic analysis of costs and benefits.
ABSTRACT Problem alcohol use among elderly persons can have a variety of health-related consequences, complicating management of chronic illnesses and increasing health care utilization and costs. This study evaluates the economic cost and benefits of brief intervention for at-risk drinking older adults.
A controlled clinical trial with 24-month follow-up tested effectiveness of brief physician advice in reducing alcohol use, health care utilization and other consequences among older (age 65 or older) adult problem drinkers. Of 6,073 patients screened for problem drinking in 24 community-based primary care practices in Wisconsin, 158 patients met inclusion criteria and were randomized into control (n = 71) or intervention (n = 87) groups. Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions including professional advice, education and contracting using scripted workbooks.
The intervention group demonstrated significant reductions in alcohol use (p = 0.001) and frequency of excessive drinking (p = 0.03) compared with the control group over 24 months, but no significant differences emerged in economic outcomes, including hospital days, emergency department visits, office visits, medications, lab and x-ray procedures, injuries, legal events or mortality.
Although the clinical benefits of brief alcohol interventions with older adults are clear, the economic results in this age group are less certain. Older adult problem drinkers may require more intensive and costly interventions to achieve economic benefits similar to those seen in younger adult problem drinkers. Methodological issues, such as statistical power, outcome measures, outlier cases and follow-up periods, are identified for future evaluations.
Full-textDOI: · Available from: Marlon P Mundt, Jun 16, 2015
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ABSTRACT: To determine whether socio-economic status (SES) influences (i) willingness to participate in brief intervention (BI) research, (ii) attendance to receive BI once allocated, and (iii) treatment outcome. Systematic review of published, randomised controlled trials of BI for non-dependent alcohol misuse in primary health care settings. Eighteen papers met inclusion criteria. There is evidence that once recruited, and following attendance for intervention, participants' SES does not influence treatment outcome. However, the effect of choosing to participate remains unclear, and the generalizability of results to the whole primary care population remains equivocal. Socio-economic status may influence willingness to participate in BI treatment research, and may influence attendance to receive such interventions where allocated. Brief interventions should remain available to all non-dependent hazardous and harmful drinkers in primary care. However, fidelity to research design is suggested to allow for any participation effects to occur. Benefits of such an approach exist for both clinicians and patients. The characteristics of those who participate in BI trials, compared to those who do not, should be studied in detail. Socio-economic variables should be included as potentially important characteristics. The impact of BI on drinking style as well as consumption needs further attention.Alcohol and Alcoholism 06/2006; 41(5):540-5. DOI:10.1093/alcalc/agl053 · 2.09 Impact Factor
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ABSTRACT: Screening and brief intervention (SBI) is increasingly available to older adults who engage in at-risk drinking. This study examined the extent to which SBI training influenced the willingness of healthcare providers in a community-based hospital and other clinical settings to promote the implementation of SBI. Ninety-three healthcare practitioners (primarily physicians, nurses, and social workers) who attended SBI training were asked about their intentions to apply the information in their professional practice, as well as their enthusiasm about recommending the training to others in their profession. Although there were no differences among the professions in terms of commitment to apply the information or level of comfort using the techniques, physicians were less interested in promoting SBI training among their colleagues. Although it may be more difficult to promote SBI in locations that don't primarily provide mental health services, results suggest that primary care settings are precisely where training may be most useful.Community Mental Health Journal 01/2015; DOI:10.1007/s10597-014-9804-x · 1.03 Impact Factor
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ABSTRACT: The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and two pharmacotherapy studies from Europe. In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.International Journal of Environmental Research and Public Health 08/2011; 8(8):3351-64. DOI:10.3390/ijerph8083351 · 1.99 Impact Factor