Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the ODHIN five country cluster randomized factorial trial

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Anderson, Peter ; Bendtsen, Preben ; Spak, Fredrik ; Reynolds, Jillian ; Drummond, Colin ; Segura, Lidia ; Keurhorst, Myrna N. ; Palacio-Vieira, Jorge ; Wojnar, Marcin ; Parkinson, Kathryn ; Colom, Joan ; Kłoda, Karolina ; Deluca, Paolo ; Baena, Begoña ; Newbury-Birch, Dorothy ; Wallace, Paul ; Heinen, Maud ; Wolstenholme, Amy ; van Steenkiste, Ben ; Mierzecki, Artur ; Okulicz- Kozaryn, Katarzyna ; Ronda, Gaby ; Kaner, Eileen ; Laurant, Miranda G.H. ; Coulton, Simon ; Gual, Toni (2016)

Abstract<br/><br/>Aim<br/><br/>To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.<br/>Design<br/><br/>Cluster randomized factorial trial with 12-week implementation and measurement period.<br/>Setting<br/><br/>Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.<br/>Participants<br/><br/>A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.<br/><br/>Interventions<br/>PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.<br/><br/>Measurements<br/>The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period.<br/><br/>Findings<br/>During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13–1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56–2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77–3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11–2.53).<br/><br/>Conclusions<br/>Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.
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