ABSTRACT
Background: With the aim of improving treatment retention in patients with the onset of alcohol-related liver disease (ArLD), we designed a blended intervention (brief motivational intervention + 'serious game' (SG)). We present the participatory design methodology and outcomes and the usability assessment of the intervention. Methods: (1) The design of the SG was based on the outcomes of two 3-h co-creation sessions with 37 participants (healthcare and technology professionals, patients, and patients' relatives). The brief face-to-face motivational intervention was based on the 5 As Model and adapted to the ArLD population. (2) Usability pilot study: 20 participants (10 ArLD patients + 10 healthcare professionals) received the intervention. System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the SG usability and patients' satisfaction with it. Weekly semi-structured interviews on the phone were conducted to identify the preferred elements in the SG and those aspects that should be improved. Results: (1) Design: an SG in the form of a gamified web app, consisting of a daily activity for six weeks and adapted brief motivational interviewing. (2) Usability pilot study: usability results were excellent for both patients and healthcare professionals (SUS median score = 85). The general usability, the quality of the information provided by the SG and the quality of the interface were very positively rated in the PSSUQ (overall median score = 2, IQR = 1-2). The best-rated aspects were the provision of feedback, the use of metaphors and the application of audiovisual material. Changes in the design, response mechanics and content were applied after the study. Conclusions: The usability and acceptability of an intervention for increasing retention to treatment in patients with recent onset of ArLD and AUD were excellent for patients and healthcare professionals. A randomized-controlled trial is required to test the efficacy of this approach.
ABSTRACT
INTRODUCTION: Alcoholic cirrhosis is one of the most common indications for liver transplantation (LT) in western countries. A major concern about transplant patients due to alcoholic liver disease (ALD) is alcoholic recidivism. Data concerning psycho-social characteristics of patients with 6 months of abstinence at initial evaluation for LT is scarce. Objectives. The aims of this study were 1) To evaluate the psycho-social profile of a cohort of patients with alcoholic cirrhosis being evaluated for LT. 2) Determine factors associated with abstinence from alcohol at initial psycho-social evaluation for LT and 3) To evaluate the potential impact of alcohol-free beer consumption on 6-month abstinence. MATERIAL AND METHODS: Ninety patients referred to the Alcohol Unit of the Hospital Clínic of Barcelona (January 1995-December 1996) were included. Univariate and multivariate logistic regression analyses were used to identify the factors associated with cessation in alcohol consumption and with 6-month abstinence. RESULTS: Factors associated with cessation in alcohol consumption were awareness of alcohol toxicity (OR = 5.84, CI 1.31-26.11, p = 0.02) and family recognition (OR = 3.81, CI 1.27-11.41, p = 0.01). Cessation of alcohol consumption at knowledge of ALD (OR = 5.50, CI 1.52-19.81, p = 0.009), awareness of alcohol toxicity (OR = 2.99, CI 1.02-9.22, p = 0.05) and family recognition (OR = 5.21, CI 1.12-24.15, p = 0.03) were the independent factors associated with 6-month abstinence previous to psycho-social evaluation for LT. CONCLUSION: In conclusion awareness of alcohol toxicity and family recognition are the independent factors that influence cessation in alcohol consumption and 6-month abstinence in patients evaluated for LT. The use of alcohol-free beer was associated with a higher rate of abstinence in patients without alcohol cessation.
Subject(s)
Alcohol Drinking/prevention & control , Alcohol Drinking/psychology , Alcoholism/psychology , Liver Cirrhosis, Alcoholic/surgery , Liver Transplantation , Temperance/psychology , Adult , Cohort Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Risk Factors , Secondary Prevention , Social SupportABSTRACT
El trasplante hepático es el único tratamiento efectivo para la cirrosis avanzada. No obstante, el número de posibles receptores es muy superior a la disponibilidad de donantes. Por tanto, se requiere una selección cuidadosa de los candidatos a trasplante para mejorar la utilización de donantes. Esta selección de candidatos es compleja en pacientes con trastornos adictivos y/o psicopatológicos. El consumo de alcohol causa una tercera parte de las hepatopatías avanzadas, en cuyos pacientes es frecuente el consumo comórbido de otras sustancias adictivas. El uso o el abuso de estas sustancias en pacientes trasplantados puede asociarse a una pérdida del injerto. A pesar de la importancia de este tema, en nuestro medio no hay un protocolo bien definido para la evaluación y la selección de pacientes con conductas adictivas y/o trastornos psicopatológicos. Por tanto, es necesario establecer una estrategia diagnóstica y terapéutica específica para estos pacientes. El Hospital Clínic de Barcelona dispone de un programa activo en trasplante hepático (90 trasplantes en el año 2007), en el que desde su inicio en 1988 la evaluación de pacientes con conductas adictivas y/o trastornos psicopatológicos se realiza de forma conjunta entre el Servicio de Hepatología y la Unidad de Alcohología, y que incluye a psiquiatras, psicólogos y trabajadores sociales. Se presenta el protocolo aprobado por el Comité de Trasplante Hepático y el Comité de Ética del Hospital Clínic en 2007, para la evaluación, la selección y el seguimiento de pacientes candidatos a trasplante con conductas adictivas y/o trastornos psicopatológicos. Este protocolo incluye una descripción del proceso de evaluación y define los criterios de inclusión y exclusión en referencia al consumo de tóxicos, a la situación sociofamilar y a los trastornos psiquiátricos. Asimismo, se detalla las recomendaciones para el seguimiento de estos pacientes(AU)
Liver transplantation is the only effective treatment for advanced cirrhosis. Nevertheless, the number of potential recipients far exceeds that of available donors. Therefore, liver transplant candidates must be carefully selected to optimize donor utilization. Candidate selection is complex in patients with addictive and/or psychopathological disorders. Alcohol consumption causes one-third of advanced liver disease in our environment and comorbid consumption of other addictive substances is frequent in these patients.The use or abuse of these substances in transplant recipients can be associated with graft loss. Despite the importance of this subject, there is no well established protocol in our environment for the evaluation and selection of candidates with addictive and/or psychopathological disorders. Therefore, a specific diagnostic and therapeutic strategy must be established for these patients. Hospital Clínic in Barcelona has an active liver transplantation program (90 transplantations in 2007). Since the start of this program in 1988, candidates with addictive and/or psychopathological disorders have been evaluated jointly by the Hepatology Service and Alcohol Unit, including psychiatrists, psychologists and social workers.We present the protocol approved by the Committee for Liver Transplantation and the Ethics Committee of Hospital Clínic in 2007 for the evaluation, selection and follow-up of transplant candidates with addictive and/or psychopathological disorders. This protocol includes a description of the evaluation process and defines the inclusion and exclusion criteria with respect to consumption of toxic substances, the social and family situation and psychiatric disorders. In addition, recommendations for the follow-up of these patients are provided(AU)
Subject(s)
Humans , Liver Transplantation/methods , Liver Cirrhosis/surgery , Behavior, Addictive , Patient Selection , Graft Survival , Alcoholism/complicationsABSTRACT
Liver transplantation is the only effective treatment for advanced cirrhosis. Nevertheless, the number of potential recipients far exceeds that of available donors. Therefore, liver transplant candidates must be carefully selected to optimize donor utilization. Candidate selection is complex in patients with addictive and/or psychopathological disorders. Alcohol consumption causes one-third of advanced liver disease in our environment and comorbid consumption of other addictive substances is frequent in these patients. The use or abuse of these substances in transplant recipients can be associated with graft loss. Despite the importance of this subject, there is no well established protocol in our environment for the evaluation and selection of candidates with addictive and/or psychopathological disorders. Therefore, a specific diagnostic and therapeutic strategy must be established for these patients. Hospital Clínic in Barcelona has an active liver transplantation program (90 transplantations in 2007). Since the start of this program in 1988, candidates with addictive and/or psychopathological disorders have been evaluated jointly by the Hepatology Service and Alcohol Unit, including psychiatrists, psychologists and social workers. We present the protocol approved by the Committee for Liver Transplantation and the Ethics Committee of Hospital Clínic in 2007 for the evaluation, selection and follow-up of transplant candidates with addictive and/or psychopathological disorders. This protocol includes a description of the evaluation process and defines the inclusion and exclusion criteria with respect to consumption of toxic substances, the social and family situation and psychiatric disorders. In addition, recommendations for the follow-up of these patients are provided.
Subject(s)
Liver Transplantation , Patient Selection , Substance-Related Disorders/diagnosis , Algorithms , HumansABSTRACT
BACKGROUND AND OBJECTIVE: Group therapy (GT) is considered a cornerstone in the treatment of alcohol dependence. Increasing numbers of foreigners are accessing alcohol treatment facilities, but efficacy of TG in those patients has not been studied. This work focuses on the influence of ethnicity and language in the compliance of GT. PATIENTS AND METHOD: 1856 consecutive patients who were referred to GT for alcohol dependence were followed until discharge or dropout. Time on treatment and final endpoint were compared according to place of birth. RESULTS: 31% of patients born in Barcelona, 39% born in Catalonia, 27% from the rest of Spain and 14.5% of foreigners (20% from Europe, 4% from America and none born in Africa (p = 0.02) completed successfully GT. The probability to stay in GT was 351, 412, 320 and 212 days (p = 0.000), respectively. DISCUSSION: Patients born abroad have lower chances to complete GT successfully, presenting with higher dropout rates and shorter treatments. The low compliance found in South American patients (who share a common language) and the better compliance found in Europeans (who are also a bit older) suggest that dropout is probably more related to social integration than to language problems.
Subject(s)
Alcoholism/therapy , Emigration and Immigration , Patient Compliance/ethnology , Psychotherapy, Group , Adult , Female , Humans , Male , Middle Aged , Patient Compliance/statistics & numerical dataABSTRACT
Se estudia la utilidad del fenómeno de la 'despedida' del consumo de alcohol como indicador de resistencia al cambio de fase del estado motivacional de los pacientes alcohólicos y si puede predecir la evolución terapéutica posterior. A una cohorte de 71 alcohólicos ingresados consecutivamente para desintoxicación enólica se les realiza alcoholuria inmediatamente después del ingreso y son evaluados al cabo de un año. La alcoholuria resultó positiva en el 47,9 por ciento de pacientes. Este porcentaje fue similar para ambos sexos e independiente de la existencia de antecedentes de tratamiento o consumo de otras drogas. Al año no se hallan diferencias en la abstinencia o el cumplimiento de tratamientos entre pacientes con alcoholuria positiva o negativa. Sin embargo en los que han hecho tratamientos previos la alcoholuria positiva es un elemento que empeora el pronóstico. Se concluye que la ausencia de 'despedida' no es buen indicador de un cambio en la motivación ni del pronóstico terapéutico si no se tienen en cuenta a otros factores (AU)
We studied the utility of the 'one last drink' prior to entering an inpatient detoxification programme as an indicator of resistance to a change of phase in the motivational state of alcoholic patients and if it could predict posterior therapeutic evolution. Urine samples of a cohort of 71 consecutive admissions for alcohol inpatient detoxification were obtained immediately after admission, and the results were compared with baseline and one year follow-up data. 47.9% of the samples screened positive for alcohol. This percentage was similar for both sexes irrespective of the existence of earlier treatment or the use of other drugs. No differences were found in abstinence or in compliance with treatment among patients who tested positive or negative for alcohol at one-year follow-up. However, in those who had undergone previous treatment, a positive analysis was a factor that predicted a poorer clinical evolution. It is concluded that the absence of 'one last drink' is not a good indicator of a change in motivation or of therapeutic prognosis if other factors are not taken into account (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Alcoholism/therapy , Inactivation, Metabolic , Prognosis , Follow-Up Studies , Cohort Studies , Temperance/statistics & numerical data , Motivation , Breath TestsABSTRACT
Fundamento: La terapia grupal es una técnica de uso muy extendido y antiguo en psiquiatría y psicología y en especial en el tratamiento del alcoholismo. A pesar de ello sigue siendo una técnica poco validada científicamente, con sectores de profesionales que dudan de su utilidad. Métodos: Para evaluar la eficacia de las terapias grupales a la hora de mantener la abstinencia de los alcohólicos y mejorar su adherencia terapéutica, se realiza un ensayo clínico con pacientes alcohólicos (criterios CIE-10) asignados aleatoriamente a dos modalidades terapéuticas: tratamiento estándar más terapia grupal (TG+, n = 45) o tratamiento estándar (TG, n = 43) durante un año. Resultados: A los 6 meses el porcentaje de consumidores de alcohol (el 26 frente al 20 por ciento) y de abandonos del tratamiento (el 49 frente al 36 por ciento) es ligeramente superior entre los pacientes del grupo TG y menor la duración acumulada de la abstinencia (131 días [DE, 57] frente a 135 días [DE, 64]), sin llegar a ser las diferencias significativas estadísticamente. Al año de tratamiento las diferencias ya son claras: el tiempo medio hasta el primer consumo (233 frente a 382 días; p = 0,04) y la probabilidad de permanecer en abstinencia (el 31 frente al 76 por ciento) es menor entre los pacientes TG. Conclusiones: Los resultados demuestran la eficacia de la terapia grupal. Su utilidad empieza a incidir a partir del tercer mes, siendo máxima a partir de los 6 meses. A pesar de ello una serie de pacientes la rechazan, precisamente los que tienen peor pronóstico. Todo ello plantea la necesidad de identificar cuidadosamente el tipo de paciente, composición de los grupos y estilo y método de los terapeutas grupales, para maximizar su eficacia. (AU)
