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

10

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

Definition of excessive useIn 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 2004Viner 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

15

Proportion of excessive substance users among participants (N=594)

Excessive use in past 30 daysProportion

% (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)

3,6 & 12 months outcome amongst those who were excessive substance users at baseline (n=279)

baseline 3 months 6 months 12 months0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

73.976.2

79.0

64.9 65.0 66.0

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                   

OUTCOMEIntervention 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 & fundersPILOT 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. JacquierDr S. JotterandDr 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

Thank you for your attention!