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Research Summary

Efficacy of Alcohol Brief Intervention in Primary Care by Nonphysicians

The best evidence for the efficacy of brief intervention (BI) for unhealthy alcohol use is in primary care. But does a physician have to deliver it? Researchers conducted a systematic review of studies of nonphysician interventions (those delivered by a nurse practitioner, nurse, health educator, counselor, psychologist, therapist, or “trained interventionist”) in primary-care settings. Thirteen studies of fair to poor quality met inclusion criteria.

  • In 3 studies comparing physician and nonphysician BI, no difference in drinking outcomes was found.
  • In 2 studies comparing the addition of a nonphysician to a physician BI, the first found no difference in drinking outcomes while the second found it further reduced drinking (5.8 versus 3.4 fewer drinks per week).
  • In 7 studies of 2210 patients, drinking was 1.7 drinks per week lower in the nonphysician BI group compared with usual care (no BI).

Comments:

These results are hypothesis-generating at best, because studies were not high quality, none had the proper design to test the equivalence of the interventions by different providers, and nurse practitioners and physician assistants were sometimes counted as physicians (and sometimes not). Although, clinically, we may wish to proceed with models of care that enlist nonphysicians for BI, we cannot say with confidence that results would be similar, although we also have little definitive evidence that they would be different. It seems reasonable to have any trained competent person deliver BI while researchers sort this question out. Richard Saitz MD, MPH

Reference:

Sullivan LE, Tetrault JM, Braithwaite RS, et al. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict. 2011;20(4):343–356.

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