{"title":"酒精短暂干预和2年医疗费用:一项成人初级保健的观察性研究","authors":"Sujaya Parthasarathy, Felicia Chi, Stacy Sterling","doi":"10.1111/add.70116","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>To compare healthcare costs over 2 years between those who did and did not receive an alcohol brief intervention (BI) among adult primary care patients screening positive for unhealthy alcohol use.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Population-based observational study, using electronic health record data.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Kaiser Permanente Northern California, a non-profit, integrated healthcare delivery system of socio-economically and demographically diverse members in California, USA.</p>\n </section>\n \n <section>\n \n <h3> Participants</h3>\n \n <p>Adult primary care patients, aged 18–85 years, who screened positive for unhealthy alcohol use between 1 January 2014 and 31 December 2017 as part of a systematic alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) program (<i>n</i> = 287 551). Patients either received a BI for unhealthy alcohol use (BI group) or did not receive a BI (non-BI group).</p>\n </section>\n \n <section>\n \n <h3> Measurements</h3>\n \n <p>Total emergency department (ED) and inpatient costs summarized in 6-month intervals from index screening through 24 months post-index; multivariable models examined associations between BI receipt and cost, and potential moderation by patient characteristics (age, sex, race/ethnicity, insurance type, clinical characteristics including body mass index, smoking status, physical activity level, the Charlson index of comorbidity, baseline drinking levels, drug and alcohol use disorders and mental health conditions in the prior year and the corresponding cost in the year prior to index date).</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>Adjusting for patient characteristics and prior-year cost, the largest declines in cost were found in the 6 months immediately following the index date for both BI and non-BI groups, and patients receiving a BI had greater reductions [estimate = −$209, 95% confidence interval (95% CI) = –$298 to –$119; estimate = –$11, 95% CI = –$14 to –$7, respectively] in total and ED costs, respectively, during this period compared with those who did not. Patients with a Charlson score ≥3 receiving a BI had lower total costs (estimate = −$621, 95% CI = −$1196 to −$46) and lower ED costs (estimate = −$24, 95% CI = −$47 to −$1) over 2 years, and patients with AUD receiving a BI had lower ED costs (estimate = −$33, 95% CI = −$66 to $0, respectively) than those who did not.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Among US adult primary care patients screening positive for unhealthy alcohol use, individuals who receive an alcohol brief intervention at the time of screening appear to have statistically significantly greater declines in healthcare costs in the 6 months following screening than individuals who do not receive an alcohol brief intervention. Moreover, receipt of an alcohol brief intervention appears to be associated with statistically significantly lower costs in two particularly vulnerable (and historically costly) patient groups: patients with alcohol use disorders and those with a Charlson score ≥3 (indicative of significant medical comorbidity).</p>\n </section>\n </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 11","pages":"2305-2318"},"PeriodicalIF":5.3000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Alcohol brief intervention and 2-year healthcare costs: An observational study in adult primary care\",\"authors\":\"Sujaya Parthasarathy, Felicia Chi, Stacy Sterling\",\"doi\":\"10.1111/add.70116\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>To compare healthcare costs over 2 years between those who did and did not receive an alcohol brief intervention (BI) among adult primary care patients screening positive for unhealthy alcohol use.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Population-based observational study, using electronic health record data.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>Kaiser Permanente Northern California, a non-profit, integrated healthcare delivery system of socio-economically and demographically diverse members in California, USA.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Participants</h3>\\n \\n <p>Adult primary care patients, aged 18–85 years, who screened positive for unhealthy alcohol use between 1 January 2014 and 31 December 2017 as part of a systematic alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) program (<i>n</i> = 287 551). Patients either received a BI for unhealthy alcohol use (BI group) or did not receive a BI (non-BI group).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Measurements</h3>\\n \\n <p>Total emergency department (ED) and inpatient costs summarized in 6-month intervals from index screening through 24 months post-index; multivariable models examined associations between BI receipt and cost, and potential moderation by patient characteristics (age, sex, race/ethnicity, insurance type, clinical characteristics including body mass index, smoking status, physical activity level, the Charlson index of comorbidity, baseline drinking levels, drug and alcohol use disorders and mental health conditions in the prior year and the corresponding cost in the year prior to index date).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Findings</h3>\\n \\n <p>Adjusting for patient characteristics and prior-year cost, the largest declines in cost were found in the 6 months immediately following the index date for both BI and non-BI groups, and patients receiving a BI had greater reductions [estimate = −$209, 95% confidence interval (95% CI) = –$298 to –$119; estimate = –$11, 95% CI = –$14 to –$7, respectively] in total and ED costs, respectively, during this period compared with those who did not. Patients with a Charlson score ≥3 receiving a BI had lower total costs (estimate = −$621, 95% CI = −$1196 to −$46) and lower ED costs (estimate = −$24, 95% CI = −$47 to −$1) over 2 years, and patients with AUD receiving a BI had lower ED costs (estimate = −$33, 95% CI = −$66 to $0, respectively) than those who did not.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Among US adult primary care patients screening positive for unhealthy alcohol use, individuals who receive an alcohol brief intervention at the time of screening appear to have statistically significantly greater declines in healthcare costs in the 6 months following screening than individuals who do not receive an alcohol brief intervention. Moreover, receipt of an alcohol brief intervention appears to be associated with statistically significantly lower costs in two particularly vulnerable (and historically costly) patient groups: patients with alcohol use disorders and those with a Charlson score ≥3 (indicative of significant medical comorbidity).</p>\\n </section>\\n </div>\",\"PeriodicalId\":109,\"journal\":{\"name\":\"Addiction\",\"volume\":\"120 11\",\"pages\":\"2305-2318\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Addiction\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/add.70116\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Addiction","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/add.70116","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
摘要
目的:比较在筛查为不健康饮酒阳性的成人初级保健患者中,接受和未接受酒精短暂干预(BI)的患者2年以上的医疗费用。设计:基于人群的观察性研究,使用电子健康记录数据。背景:Kaiser Permanente北加州,一个非营利性的综合医疗保健服务系统,由美国加利福尼亚州的社会经济和人口统计学不同的成员组成。参与者:在2014年1月1日至2017年12月31日期间,作为系统性酒精筛查、短暂干预和转诊治疗(SBIRT)项目的一部分,筛查为不健康酒精使用阳性的18-85岁成年初级保健患者(n = 287551)。因不健康饮酒而接受BI的患者(BI组)或未接受BI的患者(非BI组)。测量:从指数筛查到指数后24个月,每隔6个月汇总急诊科(ED)和住院总费用;多变量模型检验了BI收入与成本之间的关联,以及患者特征(年龄、性别、种族/民族、保险类型、临床特征(包括体重指数、吸烟状况、身体活动水平、Charlson合并症指数、基线饮酒水平、药物和酒精使用障碍、前一年的精神健康状况)和相应成本之间的潜在调节作用。研究结果:调整患者特征和前一年成本后,BI组和非BI组在指数日期后的6个月内成本下降幅度最大,接受BI的患者降低幅度更大[估计= - 209美元,95%置信区间(95% CI) = - 298美元至- 119美元;[估计= - 11美元,95% CI = - 14美元至- 7美元],在此期间的总成本和ED成本分别与未进行评估的患者相比。Charlson评分≥3的患者在2年内接受BI的总成本较低(估计= - 621美元,95% CI = - 1196美元至- 46美元),ED成本较低(估计= - 24美元,95% CI = - 47美元至- 1美元),接受BI的AUD患者ED成本较低(估计= - 33美元,95% CI = - 66美元至0美元)。结论:在美国成人初级保健筛查阳性的不健康饮酒患者中,在筛查时接受短暂酒精干预的个体在筛查后6个月内的医疗费用下降幅度在统计上显著高于未接受短暂酒精干预的个体。此外,在两种特别脆弱(历史上昂贵)的患者群体中,接受酒精短暂干预似乎与统计学上显著降低的成本相关:酒精使用障碍患者和Charlson评分≥3的患者(表明有显著的医疗合并症)。
Alcohol brief intervention and 2-year healthcare costs: An observational study in adult primary care
Aims
To compare healthcare costs over 2 years between those who did and did not receive an alcohol brief intervention (BI) among adult primary care patients screening positive for unhealthy alcohol use.
Design
Population-based observational study, using electronic health record data.
Setting
Kaiser Permanente Northern California, a non-profit, integrated healthcare delivery system of socio-economically and demographically diverse members in California, USA.
Participants
Adult primary care patients, aged 18–85 years, who screened positive for unhealthy alcohol use between 1 January 2014 and 31 December 2017 as part of a systematic alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) program (n = 287 551). Patients either received a BI for unhealthy alcohol use (BI group) or did not receive a BI (non-BI group).
Measurements
Total emergency department (ED) and inpatient costs summarized in 6-month intervals from index screening through 24 months post-index; multivariable models examined associations between BI receipt and cost, and potential moderation by patient characteristics (age, sex, race/ethnicity, insurance type, clinical characteristics including body mass index, smoking status, physical activity level, the Charlson index of comorbidity, baseline drinking levels, drug and alcohol use disorders and mental health conditions in the prior year and the corresponding cost in the year prior to index date).
Findings
Adjusting for patient characteristics and prior-year cost, the largest declines in cost were found in the 6 months immediately following the index date for both BI and non-BI groups, and patients receiving a BI had greater reductions [estimate = −$209, 95% confidence interval (95% CI) = –$298 to –$119; estimate = –$11, 95% CI = –$14 to –$7, respectively] in total and ED costs, respectively, during this period compared with those who did not. Patients with a Charlson score ≥3 receiving a BI had lower total costs (estimate = −$621, 95% CI = −$1196 to −$46) and lower ED costs (estimate = −$24, 95% CI = −$47 to −$1) over 2 years, and patients with AUD receiving a BI had lower ED costs (estimate = −$33, 95% CI = −$66 to $0, respectively) than those who did not.
Conclusion
Among US adult primary care patients screening positive for unhealthy alcohol use, individuals who receive an alcohol brief intervention at the time of screening appear to have statistically significantly greater declines in healthcare costs in the 6 months following screening than individuals who do not receive an alcohol brief intervention. Moreover, receipt of an alcohol brief intervention appears to be associated with statistically significantly lower costs in two particularly vulnerable (and historically costly) patient groups: patients with alcohol use disorders and those with a Charlson score ≥3 (indicative of significant medical comorbidity).
期刊介绍:
Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines.
Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries.
Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.