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Table 1 Study characteristics

From: Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review

Study, year

Design, study duration

Setting (country; type of health care professional)

Participants (inclusion criteria + recruitment details)

Intervention

Low intensity models of care

Moore et al., 2010 [19]

RCT

12 months

United States

Community based PC clinics

≥55 years, at risk drinkers identified by the CARET (n = 631)

Recruitment: in primary care (not seeking treatment for AUD)

Multifaceted intervention:

Personalized patient reports (educational booklet; a drinking diary). Drinking risk reports for physicians to guide drinking discussion. Telephone behavioural counselling 3x (at 2, 4, 8 weeks)

Control group:

Usual PC + a booklet outlining recommended behaviours for alcohol use, nutrition, exercise, medication use and smoking.

Ettner et al., 2014 [20]

RCT (cluster)

12 months

United States

Community based PC clinics

≥60 years, at risk drinkers identified by the CARET (n = 1186)

Recruitment: in primary care (not seeking treatment for AUD)

Educational intervention:

Emailed personalized patient report (educational booklet; a drinking diary; 13 tips sheets) at baseline and 6 months.

Drinking risk reports for physicians about patients to guide drinking discussion, handed to physician before every scheduled visit. Telephone behavioural counselling 3x (at baseline, 3-months and 6 months)

Control group:

Usual PC, which could have included alcohol counselling

Wallhed Finn et al., 2018 [21]

RCT

6 months

Sweden

Community based PC clinic

≥ 18 years, Alcohol dependence according to ICD-10.

(n = 288)

Recruitment: in primary care (not seeking treatment for AUD) + via advertisement in newspapers (seeking treatment for AUD)

15-method (stepped-care):

Various steps conducted by general physician.

Step 1: identification of problem drinking and brief advice; Step 2: Assessment + 30-min feedback; Step 3: 4 sessions based (15 min) on CBT and MET.

*Sessions can be combined with pharmacological treatment (acamprosate, disulfiram, nalmefene, or naltrexone)

*Referral to next step happened when patient score >  15 points on the AUDIT

Control group:

Specialist treatment. Same pharmacological treatment was offered as in the intervention. Various options of psychological treatment (4 to 12 sessions of 45 min)

Drummond et al., 2009 [22]

RCT

6 months

United Kingdom

Community based PC clinics

Men, age ≥ 18 years, AUDIT ≥8 and/or diagnosis of AUD using ICD-10 criteria and/or > 21 SD/week or > 8 SD/day (n = 112)

Recruitment: in primary care (not seeking treatment for AUD)

Stepped care interventions:

Step 1: 40 min session of behavioural change counselling; Step 2: MET (max four 50 min sessions on weekly basis); Step 3: referral to specialist alcohol treatment.

*Referral to next step happened when patients still consumed alcohol at hazardous levels after 4 weeks

Control group:

5-min structured brief intervention + short self-help booklet outlining consequences of excessive alcohol consumption.

Coulton et al., 2017 [23]

RCT

12 months

United Kingdom

Community based PC clinic

≥ 55 years, AUDIT ≥8 (n = 529)

Recruitment: in primary care (not seeking treatment for AUD)

Stepped-care interventions:

Step 1: 20 min session of behavioural change counselling; Step 2: MET (three 40 min sessions on weekly basis)

Step 3: referral to specialist alcohol treatment.

*Referral to next step happened when patients still consumed alcohol at hazardous levels after 4 weeks

Control group:

5-min structured brief intervention + short self-help booklet outlining consequences of excessive alcohol consumption.

High intensity models of care

Oslin et al., 2013 [24]

RCT

6.5 months

United States

VA primary care clinics

≥18 years, DSM-IV criteria for current alcohol dependence, and > 2 SD/ day for 60 days prior to randomization. (n = 163)

Recruitment: in primary care (not seeking treatment for AUD) + patient request (seeking treatment for AUD)

Alcohol care management:

Weekly 30 min visits with BHP (assess alcohol use, encouraged treatment adherence, offered support and education, monitoring medical problems, education about pharmacotherapy).

Promotion of evidence-based pharmacotherapy (naltrexone 50 mg), however use was not a requirement of participation.

As participants improved, the frequency of visits could be reduced to twice per month after the first 3 months.

Control group:

Standard specialty care at the VA specialty outpatient addiction program, based on the 12-step facilitation model, including assessments, outpatient detoxification, counselling, pharmacotherapy, psychotherapy, psycho-educational groups, outreach and referral, and acupuncture. Patients were to be expected to attend Alcoholics and Anonymous.

Watkins et al., 2017 [25]

(SUMMIT-trial)

RCT

6 months

United States

Federally qualified health center (primary care)

≥ 18 years, probable OAUD according to ASSIST.

(n = 377)

Recruitment: in primary care (not seeking treatment for AUD)

Collaborative care:

6 sessions brief psychotherapy treatment and/or medication-assisted treatment.

On-site behavioural health care, integration of addiction expertise through clinical psychologist with motivational interviewing experience, first appointment with care coordinators, entry into registry to track treatment progress and to prompt care coordinators to reach out to patients with missed appointments.

Control group:

Usual PC; participants were told that the clinic provided OAUD treatment and given a number for appointment scheduling and list of community referrals.

Upshur et al., 2015 [26]

Project RENEWAL

RCT

6 months

United States

Health care for the homeless clinic

≥ 18 years women seeking primary care services who screened positive for hazardous drinking (AUDIT-C score > 4)

(n = 82)

Recruitment: in primary care (not seeking treatment for AUD)

Chronic care model:

First, participants would get a brief intervention from the PCP and referral to the Care manager (CM) for ongoing care. PCP would provide 4–6 appointments for ongoing care and encouragement of addiction medication.

The CM was asked to complete at least 15 phone or in-person follow-up sessions in the 6 months.

Control group:

Usual PC + access to the specialty care offered in the clinic (e.g. counselling, psychiatry, etc).

Bradley et al., 2018 [27]

(CHOICE-trial)

RCT (encouragement); 12 months

United States

VA primary care clinics

Age 21–75; heavy drinking (≥4 SD/occasion for women; ≥5 SD for men) at least twice per week or once per week if prior alcohol treatment (n = 304)

Recruitment: in primary care (not seeking treatment for AUD)

Alcohol care management:

1–2 engagement visits (focus on life goals, feedback from baseline assessment, using MET/SDM). Repeated nurse visits (review patient self-monitoring and/or biomarker) + provide behavioural goal setting skills development for reducing drinking, AUD medications, withdrawal management, mutual help, and referral to specialty addictions treatment per patient preference.

Control group:

Usual PC (offered annual behavioural health screening, integrated mental health services, and access to specialty mental health and addictions clinics)

Saitz et al., 2013 [28]

(alcohol subgroup)

(AHEAD-trial)

RCT

12 months

United States

Hospital based PC clinic

≥ 18 years, Alcohol dependence according to CIDI-SF and heavy drinking in the 30 days (≥5 SD/occasion at least twice or ≥ 22 drinks per week in an average week; ≥4 and ≥ 15, respectively, for women)

(n = 409).

Recruitment: detoxification facility, referrals from hospital and advertisements (treatment seeking for AUD)

Chronic care management:

Study clinic with multidisciplinary team located in PC. Two 90-min visits separated by 3–4 days receiving assessments by all 4 clinicians. Four sessions of MET, relapse prevention, pharmacotherapy was offered as appropriate, facilitated referrals to addiction specialty care, drop in care and 24 h pager access.

Control group:

PC + a list of addiction treatment resources. They were given a phone number to access 4 MET sessions.

Willenbring et al., 1999 [29]

RCT

24 months

United States

Outpatient clinic- Minneapolis VA medical center (MVAMC)

Patients with current diagnosis of severe medical illness due to alcohol use (e.g. alcoholic liver disease, alcoholic pancreatitis, etc.), recent pathological drinking (past 6 months)

(n = 105)

Recruitment: referral by medical providers + patients were identified when presenting to acute treatment units (not seeking treatment for AUD)

Integrated outpatient treatment:

Primary care professionals are principal caregiver. First, patient receive 1–2 day inpatient evaluation by a multidisciplinary team (internist, psychiatrist, nurse practitioner, psychologist, social worker) who make a treatment plan. After which, they are seen monthly for assessment and feedback (e.g. biological indicators) and offer of a support group. Important facets of the care provided are: case management, aggressive follow-up, and family involvement.

Control group:

Standard specialty care: separate referrals for alcohol treatment and outpatient primary medical care.

Alcoholism counsellors/ mental health professionals are principal caregiver in the alcoholism treatment.

  1. CARET comorbid alcohol risk evaluation tool, AUDIT alcohol use disorder identification test, CIDI-SF Composite International Diagnostic Interview-Short Form, ASSIST Alcohol, smoking and substance involvement screening test, ICD-10 International Statistical Classification of Diseases (10th revision), DSM Diagnostic and Statistical Manual of Mental Disorders, OAUD Opioid and alcohol use disorders, GDO Good drinking outcome;
  2. * Statistically significant P < 0.05