Intervención antialcohólica en bebedores crónicos en atención primaria

Objetivo

Evaluar la evolucion del consumo de alcohol en pacientes bebedores cronicos tras la intervencion antialcoholica efectuada en atencion primaria durante 2 anos.

Diseno

Estudio prospectivo longitudinal de intervencion.

Emplazamiento

Centro de atencion primaria urbano.

Pacientes

Varones de 20–60 anos de edad consumidores de 100 o mas gramos de alcohol al dia durante, como minimo, los dos ultimos anos.

Mediciones y resultados principales

Se realizo desintoxicacion (ambulatoria u hospitalaria segun el grado de dependencia) y deshabituacion que consistia en apoyo psicologico (tecnicas de consejo breve, entrevista breve motivacional) y/o derivacion al centro de atencion y seguimiento (CAS) para psicoterapia individual y/o grupal. Se programaron un minimo de 8 visitas y se valoro el grado de consumo en g/dia al inicio y a los 1 (m1), 3 (m3), 6 (m6), 12 (m12), 18 (m18) y 24 meses (m24). Responden a la citacion 64/129 (49,5%). Visitas control: no seguimiento (0 visitas), 6 pacientes (9%), y seguimiento excelente (≥ 9 visitas), 21 pacientes (33%). Intervencion. tratamiento psicoterapico: apoyo psicologico, 55 pacientes (86%); derivacion al CAS, 4 (6%); psicoterapia de grupo, 2 (3%), y no tratamiento, 6 (9%). Datos de consumo: medias de consumo: inicio, 131 g/dia (DE, 52); m12, 31 (DE, 41), y m24, 38 (DE, 42). Porcentaje medio de reduccion del consumo a los 24 meses segun el seguimiento: insuficiente, .19%; aceptable, .71,1%, y excelente, .83,9% (p = 0,001).

Conclusiones

Baja respuesta a la citacion. Evolucion en el consumo de alcohol similar a la descrita en otros estudios. Clara relacion entre el numero de visitas y el consumo al final del estudio. Dados los resultados positivos, nos parece fundamental la intervencion antialcoholica desde atencion primaria.

Objective

To evaluate the evolution of alcohol consumption in chronic drinkers after a primary care alcohol intervention over two years.

Design

Prospective intervention study.

Setting

Urban primary care centre.

Patients

Males between 20 and 60 years old who consumed 100 or more grams of alcohol per day for at least the previous two years.

Measurements and main results

Detoxification (out-patient or hospital according to the degree of dependency) and habit-breaking, which consisted of psychological support (techniques of brief counselling, brief motivating interview) and/or referral to the care and observance centre (COC) for individual and/or group psychotherapy, took place. A minimum of eight visits were programmed and consumption was assessed in gr/day at the start and at one (1m), three (3m), six (6m), twelve (12m), eighteen (18m) and twenty-four months (24m). 64 out of 129 (49.5%) responded to the appointment. Control visits: nil observance (0 visits) 6 patients (9%), and excellent observance (≥ 9 visits) 21 patients (33%). Interventions. Psychotherapy treatment: psychological support 55 patients (86%), referral to the COC 4 (6%), group psychotherapy 2 (3%), and non-treatment 6 (9%). Data on mean consumption: start 131 g/day (SD = 52), 12m 31 (SD = 41), and 24m 38 (SD = 42). Mean reduction of consumption at 24 months according to the observance: insufficient .19%, acceptable .71.1%, excellent -83.9% (p = 0.001).

Conclusions

Low response to appointments. Evolution of alcohol consumption was similar to that in other studies. Clear relationship between number of visits and consumption at the end of the study. Given the positive findings, we think a primary care intervention on alcohol is essential.