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7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people
 

7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people

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Training family doctors to use brief intervention to address excessive substance use in young people: a cluster randomised controlled trial (PRISM-ADO) de D. Haller-Hester lors de la 7ème Journée de ...

Training family doctors to use brief intervention to address excessive substance use in young people: a cluster randomised controlled trial (PRISM-ADO) de D. Haller-Hester lors de la 7ème Journée de la Recherche Clinique

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    7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people Presentation Transcript

    • TRAINING FAMILY DOCTORS TO USE BRIEF INTERVENTION TO ADDRESS EXCESSIVE SUBSTANCE USE IN YOUNG PEOPLE: A CLUSTER RANDOMISED CONTROLLED TRIAL (PRISM-ADO) • PD Dr Dagmar M. Haller • Dr Anne Meynard • Dr Obioha C Ukoumunne • Dr Danièle Lefebvre • PD Dr Françoise Narring • PD Dr Barbara Broers • Unité Santé Jeunes • Unité des Dépendances DMCPRU & DEA
    • BINGE DRINKING
    • BINGE DRINKING CONSOMMATION DE CANNABIS
    • BINGE DRINKING 15 ans: 1x/mois->  1/3 garçons  1/4 filles HBSC 2009-2010
    • BINGE DRINKING 15 ans: 1x/mois->  1/3 garçons  1/4 filles HBSC 2009-2010 CONSOMMATION DE CANNABIS 15 ans: déjà essayé->  1/3 garçons  1/4 filles HBSC 2009-2010
    • Chen & Jacobson, JAH 2012
    • Chen & Jacobson, JAH 2012
    • PRISM-Ado_objective (Primary care Intervention addressing Substance Misuse in Adolescents)  To assess the effectiveness of training family doctors to deliver a brief intervention addressing binge drinking and/or excessive cannabis use in young people
    • Cluster randomised trial in 32 family medicine practice in French-speaking part of Switzerland 32 family doctors 16 doctors randomised to intervention arm 5 hrs training in using brief intervention with adolescents Recruitment of patients 15-24 years consulting for any reason 16 randomised to wait list control arm Wait-list for the training Recruitment of patients 15-24 years consulting for any reason
    • PRISM-Ado: PRimary care Intervention addressing Substance Misuse in Adolescents  600 young people (15 to 24 years) recruited  Completed confidential survey before consultation  Follow-up: 3, 6 & 12 months (tel)  Outcomes: binge drinking &/or cannabis use in past 30 days 10
    • Definition of excessive use In past 30 days:  Alcohol: ≥ 1episode of binge drinking  Cannabis: ≥ 1X/week Based on studies showing this threshold for negative outcomes in adulthood Bonomo Y. et al. Addiction 2004 Viner R. et al. J. Epi Com Health 2007 Coffey C et al. Br. J. Psy 2003
    • Analysis  Separately for those who were excessive users at baseline and those who were not  Regression analysis comparing alcohol and cannabis use at 3, 6 and 12 months in the intervention and the control arms.  “marginal models using Generalised Estimating Equations (GEE) with robust estimates of standard errors to allow for clustering”
    • RESULTS
    • Recruitment & follow-up BASELINE 3 months 6 months 12 months 600 patients 15-24 ans recruited 16 intervention practices INTERVENTION 287 patients 16 control practices CONTROL 307 patients 223 = 78% 249 = 87% 211 = 74% 6 patients excluded (non-valid questionnaire) 270=88% 250 = 82% 220 = 72% < 10% declined or excluded
    • Proportion of excessive substance users among participants (N=594) Excessive use in past 30 days Proportion % (95%CI)  Alcool (≥1 binge drinking) 44.9 (40.8-49.0)  Cannabis (≥1x/week) 11.1 (8.5-13.6)  Alcool &/or cannabis 48.9 (44.7-53.0) 15
    • 3,6 & 12 months outcome amongst those who were excessive substance users at baseline (n=279) 73.9 76.2 79.0 64.9 65.0 66.0 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 baseline 3 months 6 months 12 months intervention control
    • Chen & Jacobson, JAH 2012
    • Table: Proportion with the outcome in those with excessive substance use at baseline (n=279) and odds ratios for this outcome in the intervention compared to the control arm OUTCOME Intervention Arm (n=130) Control Arm (n=149) Adjusted OR p-value EXCESSIVE ALCOHOL and / or CANNABIS USE % % OR (95% CI) - at 3 months 73.9 64.9 1.2 (0.7- 2.1) 0.50 - at 6 months 76.2 65.0 1.4 (0.8- 2.7) 0.25 - at 12 months 79.0 66.0 1.6 (0.8- 3.3) 0.21
    • PRISM-Ado : Conclusions • Excessive substance = frequent • Despite recommendations, still no evidence that brief interventions delivered by primary care physicians are effective! • Yet study suggests a role for primary care in modifying young people’s substance use trajectories. • Longitudinal studies could help specify this role in the future.
    • Références  Haller DM, Meynard A, Lefebvre D, Tylee A, Narring F, Broers B. Brief intervention addressing excessive cannabis use in young people consulting family practitioners: a pilot study Br J Gen Pract. 2009;59(560):166-72.  Haller DM, Meynard A, Lefebvre D, Ukoumunne OC, Narring F, Broers B. Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial. CMAJ 2014. Epub 2014/03/13.
    • PRISM-Ado team & funders PILOT TEAM  Dr Delphine Mottu  Dr France Le Broccard  Dr Risako Suzuki  Dr Alain Michaud  Dr François George  Dr Florence Maggi  Dr Liliane Regard  Dr Daphné du Pasquier  Dr Yves Beyeler  Dr Arabelle Rieder  Mme Gwendolyn Thys Dentand  Dr Gaëtan Conti  Mmes Laure Vieux, Claudine Calvet, Clothilde Hamion, Stéphanie d’Incau, Coralie Salomon  M. Jean-Marc Schwob, Lucien Widmer, Damien Fayolle Study funded by: •Safra Foundation & Geneva University Hospitals, •Käthe-Zingg-Schwichtenberg Fund (Swiss Academy for Medical Sciences) •Swiss Federal Office of Public Health
    • Family doctors involved (general internists & paediatricians)  Dr S. Antonini Revaz  Dr F. Balavoine  Dr T. Battisti  Dr P. Berchtold  Dr M. Birchmeier  Dr F. Bovet Boone  Dr M. Bungener  Dr M. Chalier  Dr R. Chevalley  Dr C. Cuendet  Dr M. Dafflon  Dr P. Dussoix  Dr C. Extermann  Dr I. Favre  Dr C. Feroiu  Dr A. Golcea-Chittaro Dr P. Guilbert Dr Y. Heller Dr L. Herzig Dr C. Jacquier Dr S. Jotterand Dr V. Kirchner Dr P. Klauser Dr. J. Meizoz Dr P. Membrez Dr V. Paris Dr M. Perin-Minisini Dr F. Quinodoz Dr A. Rieder-Zanone Dr L. Terraz Dr R. Vasquez Dr A. Vilaseca
    • dagmar.haller-hester@hcuge.ch