A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials

Abstract

Objective: This systematic review and meta-analysis examines the effect of screening and brief intervention (SBI) on outpatient, emergency department (ED), and inpatient health care utilization outcomes. Much of the current literature speculates that SBI provides cost savings through reduced health care utilization, but no systematic review or meta-analysis examines this assertion.

Method: Publications were abstracted from online journal collections and targeted Web searches. The systematic review included any publications that examined the association between SBI and health care utilization. Each publication was rated independently by 2 study authors and assigned a consensus methodological score. The meta-analysis focused on those studies examined in the systematic review, but it excluded publications that had incomplete data, low methodological quality, or a cluster-randomized design.

Results: Systematic review results suggest that SBI has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization. A random effects meta-analysis using the Hedges method confirms the ED result for SBI delivered across settings (standardized mean difference = -0.06, I = 13.9%) but does not achieve statistical significance (confidence interval: -0.15, 0.03).

Conclusions: SBI may reduce overall health care costs, but more studies are needed. Current evidence is inconclusive for SBI delivered in ED and non-ED hospital settings. Future studies of SBI and health care utilization should report the estimated effects and variance, regardless of the effect size or statistical significance.

Figure 1. Meta-analytic results for outpatient and ED care

Figure 1a. Outpatient care forest plot Figure 1b. Emergency department care forest plot Figure 1a and 1b Legend: *Control 1: Intervention vs. control with assessment **Control 2: Intervention vs. control without assessment ***Drinking reasonably and moderately with self-control (DRAMs): DRAMs scheme vs. control ****Advice: Simple advice vs. control Caption: Effect sizes are Hedges d (i.e., within-group effect sizes) with random effects. Error bars represent 95% confidence intervals. The I-squared statistic measures heterogeneity across estimates.

Figure 1. Meta-analytic results for outpatient and ED care

Figure 1a. Outpatient care forest plot Figure 1b. Emergency department care forest plot Figure 1a and 1b Legend: *Control 1: Intervention vs. control with assessment **Control 2: Intervention vs. control without assessment ***Drinking reasonably and moderately with self-control (DRAMs): DRAMs scheme vs. control ****Advice: Simple advice vs. control Caption: Effect sizes are Hedges d (i.e., within-group effect sizes) with random effects. Error bars represent 95% confidence intervals. The I-squared statistic measures heterogeneity across estimates.