Clinical trial NCT01602172: Health Behavior Change for Hospitalized Veterans
Official title: Trial of Nurse-delivered Alcohol Brief Intervention for Hospitalized Veterans
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Alcohol Consumption
Keywords: alcohol consumption
inpatients
risk reduction behavior
counseling
nurses
brief intervention
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2012-05-18
Enrollment: 82
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Veterans drink, binge drink, and drive under the influence of alcohol at higher rates than non-Veterans do. Addressing alcohol misuse, the range of alcohol consumption from risky drinking to alcohol abuse and alcoholism, is a national priority for the VA. It is recommended that people keep their alcohol consumption below limits established by the National Institutes of Health (NIH). A type of 10-15 minute counseling known as "brief intervention" (BI) has been shown to help risky drinkers cut back to the NIH-recommended limits. This study will examine the impact of a nurse-delivered alcohol BI on hospitalized Veterans' weekly number of drinks, monthly number of binge drinking episodes, readiness to change drinking behavior, and alcohol-related problems. This preventative approach for reducing alcohol consumption is intended to help Veterans avoid many of the physical and psychosocial consequences of alcohol misuse.

Detailed description: Improving the identification and management of alcohol misuse is a VA priority. Alcohol misuse includes the spectrum of alcohol consumption ranging from hazardous drinking to alcohol use disorders (alcohol abuse and dependence). The VA recommends using a set of clinical strategies referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify and address alcohol misuse in primary care settings. Brief intervention (BI), a core component of SBIRT, significantly reduces alcohol consumption, morbidity, and healthcare utilization in hazardous drinkers, but its efficacy is not well-established outside of outpatient settings. In the hospital setting, nurses are well-positioned to deliver BI, but research is needed to determine the efficacy of inpatient nurse-delivered BI, particularly with hazardous drinkers. The few previous trials of BI in the inpatient setting demonstrated limited effects on alcohol consumption and alcohol-related problems, potentially due to assessment reactivity--extensive patient assessment that inadvertently raises patient awareness about drinking in both groups, mimicking the effect of BI and thus driving findings towards the null. Additionally, very few of these trials involved nurse delivery of the intervention and many included patients with alcohol use disorders, patients believed to be beyond the "therapeutic reach" of BI.

The primary goal of this 3-arm randomized controlled trial is to examine the efficacy of nurse-delivered alcohol BI with hospitalized patients who are hazardous drinkers and to identify barriers and facilitators to implementation of BI in inpatient settings. Arm 1 (BI) consists of Veterans randomized to nurse-delivered BI, Arm 2 (AC) consists of Veterans randomized to an attention control, and Arm 3 (AC-LA) consists of Veterans randomized to an attention control with limited assessment of readiness to change and adverse consequences of alcohol use so as to reduce and evaluate assessment reactivity.

Specific Aim 1 is to determine the impact of a nurse-led BI on the alcohol screening status, number of drinks/week, number of binge drinking episodes, readiness to change drinking behavior, and adverse consequences of alcohol use in hospitalized hazardous drinkers. Specific Aim 2 is to formatively evaluate the process of the intervention implementation to inform the design and execution of a future, multi-site randomized effectiveness trial of the intervention. A secondary aim is to identify factors, issues, and themes related to Veterans' interest and motivation for changing their alcohol consumption.

We will recruit 320 hospitalized Veterans admitted to one of the three medical-surgical units at the VA Pittsburgh Healthcare System. Veterans will be included who are \>21 years old, able to speak English, and are hazardous, non-dependent drinkers, as defined by criteria established by the National Institute for Alcohol Abuse and Alcoholism and by the Composite International Diagnostic Interview Substance Abuse Module. Patients randomized to Arm 1 will receive a three-part nurse-delivered BI. Patients randomized to Arms 2 and 3 will receive usual care plus healthy lifestyle brochures addressing general healthy lifestyle behaviors, such as limited alcohol consumption, tobacco cessation, and weight management. For Specific Aim 1, we will use various multivariable linear and logistic regressions that account for continuous outcomes, dichotomous outcomes, and clustering within medical units. Poisson regressions or negative binomial regressions will be used if the continuous outcome measures are not normally distributed. For Specific Aim 2, we will use basic descriptive statistics in order to describe the numbers of deviations and interruptions to intervention delivery as planned. Based on interventionist field notes, we will categorize the types of deviations/interruptions. We will also use these descriptive statistics to describe duration of the audio-recorded intervention; the presence/absence of various techniques within the BI; the receipt/nonreceipt of additional alcohol feedback, advice, or counseling; and patient responsiveness to/perceptions of the BI. We will also code brief free-text perceptions responses using a modified grounded theory approach.

Eligibility criteria: Inclusion Criteria:

* U.S. Veterans admitted to one of the three medical-surgical units at VA Pittsburgh Healthcare System (VAPHS)
* age 21 years or older
* ability to speak English
* hazardous, non-dependent alcohol consumption

Exclusion Criteria:

* Alcohol dependence (as determined using Section C (Alcohol) from the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)
* Current participation (past 6 months) in substance abuse treatment or 12-step program
* age \<21 years
* significant cognitive impairment (as determined by the Short Blessed test , score \>10)
* bipolar disorder or active psychosis
* sensory impairment precluding communication
* medically-related inability to participate or consent to study participation
* current pregnancy
* current incarceration
* lack of telephone access or unwillingness to be contacted for follow-up
* enrollment in the study during a prior inpatient admission at VAPHS
* current enrollment in other substance use trials (due to the potential influence of dual participation on study outcomes)

Primary outcomes:
measure: Number of Standard Drinks Per Week
timeFrame: 6 months
Secondary outcomes:
measure: Alcohol Screening Status
timeFrame: 6 months
measure: Number of Binge Drinking Episodes Over Past 30 Days
timeFrame: 6 months
measure: Readiness to Change Drinking Behavior
timeFrame: 6 months
measure: Adverse Consequences of Alcohol Use
timeFrame: 6 months
Other outcomes:
measure: Number of Participants Who Were Interested and Motivated to Change Their Alcohol Consumption
timeFrame: Baseline
Locations:
city: Pittsburgh
country: United States
facility: VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
state: Pennsylvania
Study officials:
affiliation: VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
name: Lauren M. Broyles, PhD RN
role: PRINCIPAL_INVESTIGATOR
References:
citation: Broyles LM, Wieland ME, Confer AL, Youk AO, Gordon AJ. Holes in the pipeline: addressing recruitment challenges for an alcohol brief intervention trial in the acute care setting. [Abstract]. Substance Abuse. 2014 Jan 1; 35(2):208.
citation: Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial. Addict Sci Clin Pract. 2015 May 13;10(1):13. doi: 10.1186/s13722-015-0033-6.