Research Article| Volume 26, ISSUE 5, P541-549, October 2019

Nurse practitioner alcohol intervention for people with viral hepatitis: Randomised controlled trial



      In Australia, alcohol use is accountable for 5.1% of the total burden of disease and injury along with being responsible for 24% of the burden as a result of chronic liver disease. There is a paucity of quality evidence-based programmes for alcohol use management and the chronic viral hepatitis population.


      To evaluate the effectiveness of an alcohol brief intervention for ambulatory patients with chronic viral hepatitis C attending a hepatology clinic.


      A randomised controlled trial determined the effectiveness of: a brief intervention and routine care (Group 1) compared to routine care only (no formalised intervention) (Group 2). Alcohol reduction is the primary outcome measure. Reduction in risky drinking and quality of life were also measured. Data was collected at three-time points, baseline prior to randomisation, four weeks and eight weeks.


      Alcohol intake reduced in both groups at 4 weeks, with 57% (intervention) and 41% (control) having a 50% reduction in alcohol (p = 0.295). This reduction was maintained by both groups at 8 weeks with 53% (intervention) and 43% (control) (p = 0.536). The intervention group showed a greater reduction over time, but this was not statistically significant.


      Increasing nurse led models of care, such as nurse practitioners specialising in hepatology, could provide an effective response for managing people with chronic viral hepatitis C and alcohol misuse.


      Assessing for alcohol use using the AUDIT C and TLFB_A and providing a brief intervention with routine care by the Nurse Practitioner, Hepatology is an acceptable and useful intervention to reduce alcohol consumption in this population.


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        • Australian Institute of Health and Welfare
        Australia’s health 2016.
        (Australia’s health series no. 15. Cat. no. AUS 199) AIHW, Canberra2016
        • Australian Institute of Health and Welfare
        Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of disease study 2011.
        (Australian Burden of Disease Study series no. 17. Cat. no. BOD 19) AIHW, Canberra2018
        • Bush K.
        • Kivlahan D.R.
        • McDonell M.B.
        • Fihn S.D.
        • Bradley K.A.
        The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking.
        Archives of Internal Medicine. 1998; 158: 1789-1795
        • Denis C.
        • Kampman K.
        • Pettinati H.
        • O’Brien C.
        Does substance use affect quality of life? Factors associated with quality of life in alcohol-dependent and alcohol- and cocaine-dependent patients.
        National Institute of Drug Abuse, 2012
        • Department of Health
        Fourth national hepatitis C strategy 2014–2017.
        Australian Government, 2014
        • Dieperink E.
        • Ho S.B.
        • Heit S.
        • Durfee J.M.
        • Thuras P.
        • Willenbring M.L.
        Significant reductions in drinking following brief alcohol treatment provided in a hepatitis C clinic.
        Psychosomatics. 2010; 51: 149-156
        • European Association for the Study of the Liver
        EASL clinical practice guidelines: Management of hepatitis C virus infection.
        Journal of Hepatology. 2014; 60: 392-420
        • Frank D.
        • DeBenedetti A.F.
        • Volk R.J.
        • Williams E.C.
        • Kivlahan D.R.
        • Bradley K.A.
        Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three Race/Ethnic groups.
        Journal of General Internal Medicine. 2008; 23: 781-787
        • Gastroenterological Society of Australia
        Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: A consensus statement.
        • Gitto S.
        • Micco L.
        • Conti F.
        • Andreone P.
        • Bernardi M.
        Alcohol and viral hepatitis: A mini-review.
        Digestive and Liver Disease. 2009; 41: 67-70
        • Glasgow R.E.
        • Emont S.
        • Miller D.C.
        Assessing delivery of the five’ as’ for patient-centered counseling.
        Health Promotion International. 2006; 21: 245-255
        • Hassan M.M.
        • Hwang L.Y.
        • Hatten C.J.
        • Swaim M.
        • Li D.
        • Abbruzzese J.L.
        • et al.
        Risk factors for hepatocellular carcinoma: Synergism of alcohol with viral hepatitis and diabetes mellitus.
        Hepatology. 2002; 36: 1206-1213
        • Kaner E.F.
        • Beyer F.R.
        • Muirhead C.
        • Campbell F.
        • Pienaar E.D.
        • Bertholet N.
        • et al.
        Effectiveness of brief alcohol interventions in primary care populations.
        The Cochrane Library, 2007
        • Klimas J.
        • Field C.-A.
        • Cullen W.
        • O’Gorman C.S.
        • Glynn L.G.
        • Keenan E.
        • et al.
        Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Review a.
        Systematic Reviews. 2013; 2: 3
        • Lock C.A.
        • Kaner E.
        • Heather N.
        • Doughty J.
        • Crawshaw A.
        • McNamee P.
        Effectiveness of nurse‐led brief alcohol intervention: A cluster randomized controlled trial.
        Journal of Advanced Nursing. 2006; 54: 426-439
        • Maisto S.A.
        • Conigliaro J.C.
        • Gordon A.J.
        • McGinnis K.A.
        • Justice A.C.
        An experimental study of the agreement of self-administration and telephone administration of the timeline followback interview *.
        Journal of Studies on Alcohol and Drugs. 2008; 69 (Retrieved from): 468+
        • Manning M.
        • Smith C.
        • Mazerolle P.
        The societal costs of alcohol misuse in Australia.
        Trends and issues in crime and criminal justice. 2013; 454: 1
        • Markland D.
        • Ryan R.M.
        • Tobin V.J.
        • Rollnick S.
        Motivational interviewing and self–determination theory.
        Journal of Social and Clinical Psychology. 2005; 24: 811-831
        • Miller W.R.
        • Rollnick S.
        Motivational interviewing: Helping people change.
        Guilford press, 2012
        • Moyer A.
        • Finney J.W.
        • Swearingen C.E.
        • Vergun P.
        Brief interventions for alcohol problems: A meta‐analytic review of controlled investigations in treatment‐seeking and non‐treatment‐seeking populations.
        Addiction. 2002; 97: 279-292
        • Murphy B.
        • Herrman H.
        • Hawthorne G.
        • Pinzone T.
        • Evert H.
        Australian WHOQOL instruments: Users’s manual and interpretation guide.
        Australian WHOQOL Field Study Centre, Melbourne, Australia2000
        • Nkowane A.M.
        • Saxena S.
        Opportunities for an improved role for nurses in psychoactive substance use: Review of the literature.
        International Journal of Nursing Practice. 2004; 10: 102-110
        • O’Donnell A.
        • Anderson P.
        • Newbury-Birch D.
        • Schulte B.
        • Schmidt C.
        • Reimer J.
        • et al.
        The impact of brief alcohol interventions in primary healthcare: A systematic review of reviews.
        Alcohol and Alcoholism. 2014; 49: 66-68
        • Palmer W.C.
        • Patel T.
        Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma.
        Journal of Hepatology. 2012; 57: 69-76
        • Persico M.
        • Bruno S.
        • Costantino A.
        • Mazza M.
        • Almasio P.L.
        The impact of antiviral therapy and the influence of metabolic cofactors on the outcome of chronic HCV infection.
        International Journal of Hepatology. 2011; 2011
        • Platt L.
        • Melendez-Torres G.J.
        • O’Donnell A.
        • Bradley J.
        • Newbury-Birch D.
        • Kaner E.
        • Ashton C.
        How effective are brief interventions in reducing alcohol consumption: Do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis.
        British Medical Journal Open. 2016; 6 (e011473)
        • Reid C.
        • Fenech
        • Skoien R.
        • Daglish M.
        • Jones L.
        Motivational Interviewing for people with chronic viral hepatitis and who drink alcohol: A randomised controlled trial.
        Sexually Transmitted Infections. 2015; 91: A1-A258
        • Roche A.
        • Kostadinov V.
        • Fischer J.
        • Nicholas R.
        The social determinants of inequities in alcohol consumption and alcohol-related health outcomes.
        Australian’s National Research Centre on AOD Workforce Development, Flinders University, 2015
        • Rodgers C.
        Brief interventions for alcohol and other drug use.
        Australian Prescriber. 2018; 41: 117-121
        • Rosenbaum A.
        • Rabenhorst M.M.
        • Reddy M.K.
        • Fleming M.T.
        • Howells N.L.
        A comparison of methods for collecting self-report data on sensitive topics.
        Violence and Victims. 2006; 21: 461-471
        • Saatcioglu O.
        • Yapici A.
        • Cakmak D.
        Quality of life, depression and anxiety in alcohol dependence.
        Drug and Alcohol Review. 2008; 27: 83-90
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        • for the CONSORT Group
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
        British Medical Journal. 2010; 340: c332
        • Shand F.
        • Gates J.
        • Fawcett J.
        • Mattick R.
        The treatment of alcohol problems: A review of the evidence. Book the Treatment of Alcohol Problems: A Review of the Evidence.
        • Sobell L.C.
        • Sobell M.B.
        Alcohol consumption measures.
        Assessing alcohol problems: A guide for clinicians and researchers. 1995; 2: 75-99
        • Tucker J.S.
        • Burnam M.A.
        • Sherbourne C.D.
        • Kung F.-Y.
        • Gifford A.L.
        Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection.
        The American Journal of Medicine. 2003; 114: 573-580
        • Vakili S.
        • Sobell L.C.
        • Sobell M.B.
        • Simco E.R.
        • Agrawal S.
        Using the Timeline Followback to determine time windows representative of annual alcohol consumption with problem drinkers.
        Addictive Behaviors. 2008; 33: 1123-1130
        • World Health Organization (WHO)
        Global status report on alcohol and health.
        • World Health Organization
        Global status report on alcohol and health 2014.