Citation

Anderson P, Coulton S, Kaner E, Bendtsen P, Kłoda K, Reynolds J, Segura L, Wojnar M, Mierzecki A, Deluca P, Newbury-Birch D, Parkinson K, Okulicz-Kozaryn K, Drummond C, Gual A. Ann. Fam. Med. 2017; 15(4): 335-340.

Affiliation

Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond).

Copyright

(Copyright © 2017, Annals of Family Medicine, Inc.)

DOI

10.1370/afm.2051

PMID

28694269

Abstract

PURPOSE: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool.

METHODS: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months.

RESULTS: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention.

CONCLUSIONS: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

© 2017 Annals of Family Medicine, Inc.

Language: en

Keywords

electronic brief intervention; financial reimbursement; heavy drinking; implementation study; practice-based research; primary health care; training and support