This review concluded that screening and brief interventions had little to no effect on in-patient or outpatient healthcare utilisation in non alcohol-dependent populations, but may reduce emergency department utilisation. Heterogeneity between the pooled studies and the possibility of publication bias mean these conclusions should be interpreted with caution.

To investigate the effect of screening and brief intervention in non-alcohol dependent populations on health care utilisation.

PubMed, CINAHL, The Cochrane Library, EBSCO, JSTOR and PsycARTICLES were searched to 2010 for published studies in English. Search terms were reported. Reference lists of retrieved studies, systematic reviews and meta-analyses were examined for further studies.

Primary studies of brief interventions conducted in a non-alcohol dependent population that reported a health care utilisation outcome in alcohol-focused publications were eligible for inclusion.

The included studies were conducted in UK, Australia, Canada, Sweden, Switzerland and USA. Most were conducted in a primary care setting; others were in an emergency department or non-emergency department hospital setting. Participants in the included studies varied and were general population, men or women only, diabetic/hypertensive/other medical condition, older adults, young adults, injured, surgery, in-patients and military. The outcome measures reported were outpatient or GP (general practitioner) visits and consultation rates.

One reviewer selected studies for inclusion. Two other reviewers conducted random sample screening to assess quality and accuracy.

Methodological quality was assessed using previously published criteria (Miller et al.) of a 12-item checklist to produce a quality score out of 17. Studies that scored between 14 and 17 were considered excellent quality.

The assessment was performed independently by two reviewers Disagreements were resolved by consensus.

Standardised mean difference (SMD) and associated 95% confidence intervals (CI) were calculated for each study. Data were extracted by one reviewer and checked by another. Authors of primary studies were contacted for further information if necessary.

Summary standardised mean differences and 95% CIs were estimated using a random-effects meta-analysis. Studies were excluded from the meta-analysis if they were of poor methodological quality or used a cluster randomised controlled trial (RCT) design. Heterogeneity was assessed with Ι².

Twenty-nine studies were included in the review (13,184 participants, range 72 to 3,628): 23 RCTs (8,363 participants), one mixed quasi-experimental/RCT (414 participants), two cluster RCTs (3,755 participants), two quasi-experimental studies (208 participants) and one observational study (444 participants). Quality scores ranged from 5 to 16 (median 13).

Screening and brief interventions were not significantly associated with uptake of outpatient care (SMD 0.13, 95% CI -0.00 to 0.28, Ι²=53.4%; nine studies), emergency department care (SMD -0.06, 95% CI -0.15 to 0.30, Ι²=13.9%; six studies) or in-patient care (SMD 0.02, 95% CI -0.12 to 0.15, Ι²=69.7%; number of studies not reported).

Screening and brief interventions had little to no effect on in-patient or outpatient healthcare utilisation but may reduce emergency department utilisation.

The research question was supported by inclusion criteria for participants, outcomes and interventions. Only studies published in English were included, so publication and language biases were possible. Two reviewers were involved in quality assessment and data extraction, which reduced the possibility of error and bias; only a subsample of studies were screened for inclusion in duplicate. Study quality was assessed and taken into consideration in the analysis, but no details of quality items fulfilled and not fulfilled were reported. As only overall quality scores were reported, types of bias that may have been present in the studies could not be ascertained. Considerable heterogeneity in setting, form and quality of interventions meant that it may not have been appropriate to pool the studies in a meta-analysis.

The authors' conclusions reflected the data presented, but heterogeneity between the pooled studies and the possibility of publication bias suggest caution should be used when interpreting the conclusions.

Practice: The authors did not state any implications for practice.

Research: The authors stated a need for further research on the effects of screening and brief interventions on health care utilisation conducted in primary care settings.

National Institute on Alcohol Abuse and Alcoholism, USA.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.