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Journal Club

Explore whether referral to treatment in alcohol screening brief intervention leads to further treatment. Validity, results, and implications for patient care are analyzed in this meta-analysis study.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2015 www.aodhealth.org

  2. Featured Article Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials Glass JE, et al. Addiction. 2015;110(9):1404–1415.

  3. Study Objective • To determine whether the “referral to treatment” component of alcohol screening, brief intervention, and referral to treatment (SBIRT) is leading to treatment. www.aodhealth.org

  4. Study Design • Systematic review and meta-analysis. • Studies were randomized controlled trials (RCTs) of brief alcohol interventions in general health care settings among adults and adolescents. www.aodhealth.org

  5. Assessing an Overview Article (Systematic Reviews and Meta-Analyses) • Are the results of the study valid? • What are the results? • Will the results help me in caring for my patients? www.aodhealth.org

  6. Are the Results of the Study Valid? • Did the overview address a focused clinical question? • Were the criteria used to select articles for inclusion appropriate? • Is it unlikely that important, relevant studies were missed? • Was the validity of the included studies appraised? • Were assessments of studies reproducible? • Were the results similar from study to study? www.aodhealth.org

  7. Did the overview address a focused clinical question? • Yes. • Main outcomes: • Post-intervention alcohol services utilization determined via self-report or administrative data. www.aodhealth.org

  8. Were the criteria used to select articles for inclusion appropriate? • Yes. • 13 randomized controlled trials met inclusion criteria; 9 were included in the meta-analysis. • Articles were published in English up until 2013 and available in electronic databases. • Studies had to have had an alcohol intervention in a general healthcare setting. • Participants must not have been seeking treatment. • Studies were excluded if they did not include health services utilization data. www.aodhealth.org

  9. Is it unlikely that important, relevant studies were missed? • Yes. • The authors searched PubMed, the Cochrane Library, PsycINFO, and CINAHL Plus through 26 July, 2013. • They also did a hand search of peer-reviewed and grey papers by the references in the included articles and contacted authors to ask if they knew of other existing studies. www.aodhealth.org

  10. Was the validity of the included studies appraised? • Yes. • Two authors independently reviewed the articles and performed the data extraction. www.aodhealth.org

  11. Were assessments of studies reproducible? • Yes. • The authors state their specific criteria for grouping of studies and classifying intervention intensity and severity of alcohol use. • Two authors independently reviewed papers. • Data extraction used standardized forms • Meetings were held to identify and resolve discrepancies. www.aodhealth.org

  12. Were the results similar from study to study? • Yes. • The I2 statistic for the 9 studies included in the meta-analysis was 0%, indicating no evidence of study heterogeneity www.aodhealth.org

  13. What Are the Results? • What are the overall results of the review? • How precise were the results? www.aodhealth.org

  14. What are the overall results of the review? • Referral to alcohol treatment did not lead to treatment following alcohol SBIRT. • Subgroup analyses yielded non-statistically significant results. www.aodhealth.org

  15. How precise were the results? • For the primary outcome of receipt of alcohol treatment following SBIRT, the pooled risk ratio was = 1.08, 95% confidence interval = 0.92-1.28. www.aodhealth.org

  16. Will the Results Help Me in Caring for My Patients? • Can the results be applied to my patient care? • Were all clinically important outcomes considered? www.aodhealth.org

  17. Can the results be applied to my patient care? • Yes. • Study participants were non-treatment seeking adults and adolescents in general healthcare settings in 5 countries. www.aodhealth.org

  18. Were all clinically important outcomes considered? • Yes. www.aodhealth.org

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