Research shows intervention within a primary care setting for smoking and excessive alcohol consumption is effective. But what happens when a patient is scheduled for surgery?
A group of researchers in Columbia launched a clinical trial (ClinicalTrials.gov Identifier: NCT03521622) to assess whether a short stint of in-hospital counseling would have an impact on tobacco and alcohol consumption. They published the details of their study, which is ongoing, in Revista Colombiana de Psiquiatria (English Edition).
The randomized controlled superiority trial compares the use of brief behavioral counseling tailored to a patient’s risk factors (active smoking, “risky” alcohol use, or both) to the usual care, which consists of written educational intervention from the Colombian Ministry of Health and Social Protection. The trial is being conducted at the San Ignacio University Hospital, in Bogotá, Colombia.
The study recruited a total of 438 men and women between ages 19 and 64 who were undergoing a diagnostic procedure or surgery in the hospital. Risk factors considered include tobacco smoking of any amount in the previous month, excessive alcohol consumption at least once in the past year, and/or an Alcohol Use Disorders Identification Test (AUDI) score between 8 and 15. The researchers anticipate a 10% dropout rate and aim for a sample size of 199 patients in each control arm.
The behavioral intervention includes 1 session of 5 to 15 minutes, followed by a reinforcement session and follow up calls at the 1 and 3-month mark. The intervention varies by condition. Smokers who want to quit receive counseling based on a “5 As” strategy (ask, advise, assess, assist, arrange). Those with no motivation to change receive counseling based on a “5 Rs” model (relevance, risks, rewards, roadblocks, repetition). Change-motivated alcohol users receive simple advice while the unmotivated will receive an interview-based counseling.
Physicians will record data using standardized forms prepared by the researchers. For quality control, the researchers will randomly select 10% of the interviews for expert evaluation.
“Like similar studies conducted in the outpatient setting, this study will provide novel evidence on the effectiveness of brief counseling interventions in the hospital setting,” the researchers concluded. “Moreover, we aim to demonstrate that the screening instruments, behavioral interventions and follow-up strategies used in primary care are also effective in a high-complexity hospital.”
Almonacid I, Olaya L, Cuevas V, et al. Effectiveness of brief counseling in a hospital setting for smoking cessation and risky alcohol drinking reduction: randomized clinical trial protocol. Rev Colomb Psiquiatr (Engl Ed). Published online June 15, 2022. doi:10.1016/j.rcpeng.2020.06.003