Flipped classroom & gamification - 7ème forum des Enseignants Innovants
7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to...
-
Upload
hopitaux-universitaires-de-geneve -
Category
Health & Medicine
-
view
265 -
download
1
description
Transcript of 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to...
![Page 1: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/1.jpg)
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
![Page 2: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/2.jpg)
BINGE DRINKING
![Page 3: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/3.jpg)
BINGE DRINKING
CONSOMMATION DE CANNABIS
![Page 4: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/4.jpg)
BINGE DRINKING
15 ans: 1x/mois->
1/3 garçons 1/4 filles
HBSC 2009-2010
![Page 5: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/5.jpg)
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
![Page 6: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/6.jpg)
Chen & Jacobson, JAH 2012
![Page 7: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/7.jpg)
Chen & Jacobson, JAH 2012
![Page 8: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/8.jpg)
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
![Page 9: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/9.jpg)
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
![Page 10: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/10.jpg)
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
![Page 11: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/11.jpg)
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
![Page 12: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/12.jpg)
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”
![Page 13: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/13.jpg)
RESULTS
![Page 14: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/14.jpg)
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
![Page 15: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/15.jpg)
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)
![Page 16: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/16.jpg)
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
![Page 17: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/17.jpg)
Chen & Jacobson, JAH 2012
![Page 18: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/18.jpg)
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
![Page 19: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/19.jpg)
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.
![Page 20: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/20.jpg)
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.
![Page 21: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/21.jpg)
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
![Page 22: 7ème Journée de la Recherche Clinique: Training family doctors to use brief intervention to address excessive substance use in young people](https://reader036.fdocuments.us/reader036/viewer/2022081603/559197c61a28abda668b4702/html5/thumbnails/22.jpg)
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