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.
- primary health care
- heavy drinking
- implementation study
- training and support
- financial reimbursement
- electronic brief intervention
- practice-based research
Footnotes
Conflicts of interest: Dr Gual reports grants and personal fees from Lundbeck and D&A Pharma, grants from Teva, and personal fees from AbbVie, outside the submitted work. The other authors report having no conflicts of interest.
Author contributions: All authors except P.A. and S.C. were involved in implementing the trial in their jurisdictions. S.C. and P.A. undertook analyses. P.A. wrote drafts of the manuscript. All other authors revised the manuscript critically. All authors read and approved the final manuscript.
Disclaimer: Views expressed are those of the author(s) and not necessarily those of NHS, NIHR, Department of Health, or European Commission.
Trial registration: ClinicalTrials.gov. Trial identifier: NCT01501552.
CONSORT statement: This article adheres to the CONSORT (Consolidated Standards of Reporting Trials) 2010 guidelines.18
Funding support: The research leading to these results or outcomes has received funding from the European Union’s Seventh Framework Programme for Research, Technological Development, and Demonstration under grant agreement no. 259268: Optimizing Delivery of Healthcare Interventions (ODHIN). Organizations participating in ODHIN can be seen at www.odhinproject.eu. Radboud University Medical Center received cofunding from The Netherlands Organisation for Health Research and Development (ZonMW, Prevention Program), under grant agreement no. 200310017 – ODHIN – Optimizing Delivery of Healthcare Interventions in the Netherlands, according to Art.II.17 of the FP7 EC Grant Agreement. Colin Drummond is partly funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London and partly funded by the NIHR Collaborations for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. Both Medical University of Warsaw and Pomeranian Medical University in Szczecin received cofunding for the ODHIN project from the Polish science financial resources in the years 2011–2014.
- Received for publication August 23, 2016.
- Revision received January 2, 2017.
- Accepted for publication January 11, 2017.
- © 2017 Annals of Family Medicine, Inc.
