Using Recovering Alcoholics to Help Hospitalized Patients with Alcohol Problems

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Original Research

Using Recovering Alcoholics to Help Hospitalized Patients with Alcohol Problems

J Fam Pract. 2001 May;50(5):1-12

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We use the exact version of the Cochran-Armitage test for trend²⁸ to test the null hypothesis of no difference among the treatment groups against the alternative hypothesis that the true proportions of positive outcomes would be in the following order: control < brief intervention < peer intervention (ie, we hypothesized that the success rate for the peer intervention group would be greater than that for the brief intervention group and that the success rate for the brief intervention group would be greater than that for the control group). If a significant difference was found among the treatment groups, we used the Fisher exact test with a Bonferroni adjustment to determine which pairs of treatment groups differed from each other. Stratified analysis was used to adjust for the effect of any confounding variables.

A sample size of 28 per group was sufficient to achieve 80% power for detecting differences in success rates (as measured by initiation of treatment or self-help) among the groups of 5% in the control group, 10% in the brief intervention group, and 30% in the peer intervention group using a one-tailed significance level of 0.05. All computations for the study were performed using Epi Info Version 6.04c (USD Inc, Stone Mountain, Ga, 1999), StatXact 4.0.1 (CYTEL Software Corp, Cambridge, Mass, 1998), and SPSS software version 10.0 (SPSS, Inc, Chicago, Ill, 1999). Continuous variables were summarized as mean plus or minus the standard deviation.

Results

Of the 314 patients in the study 258 (82.2%) were men; 244 (77.7%) were white; and the mean age was 37.2 years plus or minus 12.5 years (range=18-80). The mean blood alcohol concentration on admission for these 314 patients was 35.8 mmol per L plus or minus 26.5 mmol per L (165 mg/dL±122 mg/dL ) with a range of 00.0 to 143.3 mmol per L (000-660 mg/dL).

Of the 314 patients in our study, 140 (44.6%) were contacted following hospital discharge through communication with the subject, the subjects’ relatives, or both. Among the members of the control group, the follow-up rate was 35.2% (44/125); among those who received a brief intervention it was 47.9% (57/119); and among those who received a peer intervention, it was 55.7% (39/70). This represents a statistically significant difference at the Bonferroni cutoff of 0.05 divided by 3 (0.0167) between the control and peer intervention groups (P=.003) but not between the control and brief intervention groups (P=.023), or the brief and peer intervention groups (P=.152) using the Fisher exact test Table 1.

Among the 140 patients in the study, follow-up data were obtained from the patient in 97 instances (69%), from a friend or family member in 38 (27%), and from other sources in 5 (4%). For the 44 members of the control group, follow-up data were obtained from the patient in 37 instances (84%), from a friend or family member in 6 (14%), and from other sources in 1 (2%). For the 57 patients who received a brief intervention, follow-up data were obtained from the patient in 35 instances (61%), from a friend or family member in 21 (37%), and from other sources in 1 (2%). For the 39 patients who received a peer intervention, follow-up data were obtained from the patient in 25 instances (64%), from a friend or family member in 11 (28%), and from other sources in 3 (8%). The Fisher-Freeman-Halton test indicates a significant difference between the control and brief intervention groups (P=.012) but no difference between the control group and the peer intervention group (P=.117) or between the brief and peer intervention groups (P=.341), using the Bonferroni criterion of 0.0167. Those patients for whom follow-up data could be obtained were compared with those for whom it could not be obtained in terms of age, race, sex, and BAC on admission. The only significant difference that was found was for race: Follow-up data were available for 49.2% of the white patients but for only 28.6% of the nonwhite patients (P=.003). In terms of sex, follow-up data were available for 42.2% of the men and 55.4% of the women (P=.051). The mean age of those for whom follow-up data were available was 38.1 years plus or minus 12.8, compared with 36.4 years plus or minus 12.3 for those lost to follow-up (P=.226). The mean BAC on admission was 38.0 mmol per L plus or minus 27.8 (175 mg/dL±128) for those we were able to follow up, compared with 34.1 mmol per L plus or minus 25.4 (157 mg/dL±117) for those lost to follow-up (P=.233).

Comparisons of the baseline characteristics of the 140 patients across the 3 treatment groups are shown in Table 2. No significant differences were found at baseline between the groups at the 0.05 level except for male sex (P=.003); however, BAC almost reached statistical significance (P=.054).