Erroneous POEM Analysis on Alcohol Screening and Intervention

By Richard L. Brown, MD, MPH

Earlier this year, a randomized control trial by Eileen Kaner analyzing the effectiveness of screening and brief alcohol intervention in primary care settings was released. It concluded that, “All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. “

I believe an analysis of the trial by Essential Evidence Plus POEM, which stated the bottom line was that alcohol screening and intervention did not decrease the percentage of patients drinking to excess at six months, completely misinterpreted Kaner’s study.

Kaner’s study did not assess the efficacy of alcohol screening and intervention, which is already well-established in dozens of randomized controlled trials, including Mike Fleming’s seminal study published in JAMA in the 1990s. Kaner’s study assessed the effectiveness of training physicians and nurses in primary care settings in delivering these services. And of course, the physicians and nurses did poorly, because they simply don’t have time to adequately screen and intervene.

The message that I take away from Kaner’s study is:

  • If you really want to generate the improved health outcomes and cost savings that alcohol screening and intervention will yield, you need to expand your healthcare team with staff who have the time to deliver these services.
  • The same goes for evidence-based – widely-recommended, yet seldom delivered – evidence-based interventions for tobacco and depression.
  • We can increase one-year quit rates from 6% to as high as 28% if we have additional staff who can spend as much as five hours with each patient over more than eight visits, according to a metaanalyses published in the most recent update of the Federal Guideline for Tobacco Cessation.
  • We can increase one-year rates of complete remission from depression from 30% to 54% if we have additional staff who can deliver “collaborative care,” which includes educating patients, engaging them fully in treatment and in behaviors that help lift symptoms (such as exercise and socializing), tracking depressive symptom scores (PHQ-9), and alerting other providers when poor improvement in PHQ-9 scores indicates a need to reconsider the treatment plan. (See a metaanalysis of 69 studies by Thota, Am J Prev Med, 2012.)

If you have questions regarding Kaner’s study, the POEM analysis or my response to the POEM analysis, please email me at info@wiphl.org.

For more information, see wiphl.org.


WIPHL Announces “The Time Is Now:” September Symposium on Behavioral Screening and Intervention

Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) announced the 2013 WIPHL Symposium on Behavioral Screening and Intervention (BSI) will be held September 17 at the Monona Terrace in Madison. The day-long event will be free and open to the public.

More than 20 experts will deliver presentations on the importance of BSI services at the Symposium, including a keynote address by John Torinus, Chairman of Seriograph, Inc. and the author of the book, “The Company That Solved Health Care.” Presenters also include leaders from The Alliance, Business Healthcare Group, Council on AODA of Washington County, University of Wisconsin-Whitewater, Wisconsin Collaborative for Health Care Quality, Wisconsin Department of Health Services, Wisconsin Primary Health Care Association and various healthcare clinics across Wisconsin.

“The time is now for behavioral screening and intervention. As WIPHL’s director, I am very excited for the breadth of participation in the Symposium from healthcare providers and purchasers, businesses, policymakers and advocates,” said Dr. Richard L. Brown, MD, MPH. “We look forward to bringing together leaders, advocates and those new to BSI for a substantive discussion of real-world solutions to continuing the expansion of cost-saving, proven-effective BSI.”

More than 200 attendees are expected to take part in WIPHL’s Symposium. The event will offer panel, discussions, valuable presentations and networking opportunities to discuss the facilitators and barriers of implementing BSI in addition to encouraging the dissemination of the services in Wisconsin.

To register and view the full agenda, visit http://onlinecommunity.wchq.org/event/BSIsymposium.

BSI screens all patients annually by questionnaire for behavioral risks in general healthcare settings. These services are aimed at reducing tobacco use, unhealthy drinking, drug use, depression and obesity, which, in total, are responsible for more than 40 percent of deaths in the United States each year.

For more information on BSI, visit www.wiphl.org.