title: Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials.
abstract: BACKGROUND
  Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.
  
  
  METHODS
  Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.
  
  
  RESULTS
  In the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months.
  
  
  CONCLUSIONS
  Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN89156543; registered 21 October 2013.
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK. graeme.wilson@ncl.ac.uk.
authors.forename: Graeme B
authors.initials: GB
authors.lastname: Wilson
authors.forename: Catherine
authors.initials: C
authors.lastname: Wray
authors.forename: Ruth
authors.initials: R
authors.lastname: McGovern
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.forename: Elaine
authors.initials: E
authors.lastname: McColl
authors.forename: Ann
authors.initials: A
authors.lastname: Crosland
authors.forename: Chris
authors.initials: C
authors.lastname: Speed
authors.forename: Paul
authors.initials: P
authors.lastname: Cassidy
authors.forename: Dave
authors.initials: D
authors.lastname: Tomson
authors.forename: Shona
authors.initials: S
authors.lastname: Haining
authors.forename: Denise
authors.initials: D
authors.lastname: Howel
authors.forename: Eileen F S
authors.initials: EF
authors.lastname: Kaner
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D012107:Research Design; D040242:Risk Reduction Behavior