Details of HTA project
Last updated: 21 May 2013 - Next update due: 28 May 2013
Research type: |
Primary Research (e.g. trial) |
Project title: |
The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) |
Project ref: |
06/304/142 |
Cost: |
£1,090,210 |
Chief Investigator : |
Professor Simon Coulton, Professor of Health Service Research, Centre for Health Service Studies, University of Kent |
Start Date: |
April 2007 |
Estimated date of publication in HTA journal series: |
June 2013. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
There exists a wealth of evidence about the detrimental impact of hazardous alcohol consumption on health. In older people hazardous alcohol consumption is associated with increased risk of heart disease, stroke, cancers, the onset of dementia and is a major risk factor for falls. Alcohol use in older people is considered a hidden problem, in part because of a reticence on the part of people to seek help and treatment and in part because of wide scale misdiagnosis. The prevalence of hazardous alcohol consumption in older people is far higher than initially thought, about 20%, but only a small percentage receive any treatment. We propose a proactive reliable approach to screen older people for alcohol use disorders whilst attending for primary care appointments. For those who do have an alcohol use disorder we aim to compare a treatment as usual approach, involving brief advice, with a stepped care approach. Stepped care is a logical rational approach in which more invasive and intensive treatments are only delivered to those who do not benefit from less intensive and invasive approaches. The steps we will use are a short motivational intervention delivered by a practice nurse followed by a more intensive motivational therapy delivered by a trained therapists, both of these approaches have shown reductions in alcohol consumption in other studies. If neither of these benefit the patient we will refer them to specialist alcohol services. We will assess the outcome of our study by analysing changes in alcohol consumption, alcohol problems and quality of life for all patients over 12 months. We will also explore the costs of each treatment and what potential savings can be made to the NHS. There are no known detrimental effects from the interventions proposed, but we will ensure we have a full independent ethical review before any patients are screened. The group conducting the research involves expertise from alcohol research, clinical experts in the treatment of alcohol use disorders and primary care. Most of who have been extensively involved in research into interventions for alcohol use disorders for many years. We have requested costs to conduct the research including researchers to interview patients, statistical and economic analysts to interpret the results and the administrative costs of running the study. We have also asked for costs to cover the training of practice nurses and therapists to conduct the interventions and all costs associated with running the study in primary care centres. |
Project Abstract: |
The proposed study is a pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care. Primary care attendees aged 55 years or over who are consuming alcohol at hazardous levels will be randomised to either minimal intervention or stepped care intervention. Stepped care consists of three successive steps of increasing intensity; behavioural change counselling delivered by a practice nurse, motivational enhancement therapy delivered by a trained therapist and specialist intervention. Progression to successive steps is dependent upon the outcome of each prior step. Outcomes will be measured at baseline, prior to randomisation and then again at 6 and 12 months after randomisation. The primary outcome measure is the quantity of alcohol consumed in standardised drinks, secondary outcome measures include frequency of alcohol consumption, alcohol related problems, quality of life and health utility. Health and social care resource use will be collected at baseline, 6 and twelve months to inform the cost-effectiveness analysis. The sample size of the study requires 500 participants derived from 15 primary care centres in 3 geographical areas of the United Kingdom. |
NRR* number, if applicable: |
N0484190633 (*National Research Register). The National Research Register was a public database of ongoing and recently completed research projects funded by, or of interest to, the United Kingdom's National Health Service (NHS). It is now an archive of projects from early 2000 to September 2007. Search the NRR archive. |
ISRCTN* number: | ISRCTN 52557360 (*International Standard Randomised Controlled Trial Number) URL of this project on the Controlled Trials Website: http://www.controlled-trials.com/ISRCTN52557360 |
Project Protocol: |
Project protocol (pdf format, 146 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1608 |
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