Erroneous POEM Analysis on Alcohol Screening and InterventionPosted: July 11, 2013
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 email@example.com.
For more information, see wiphl.org.