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Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial
Newcastle University, England; Maastricht University, Netherlands.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
University of Gothenburg, Sweden.
Hospital Clin Barcelona, Spain.
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2016 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 11, 1935-1945 p.Article in journal (Refereed) Published
Abstract [en]

AimTo 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. DesignCluster randomized factorial trial with 12-week implementation and measurement period. SettingPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. ParticipantsA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. InterventionsPHCUs 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. MeasurementsThe 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. FindingsDuring 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). ConclusionsProviding 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.

Place, publisher, year, edition, pages
WILEY-BLACKWELL , 2016. Vol. 111, no 11, 1935-1945 p.
Keyword [en]
Brief interventions; financial reimbursement; heavy drinking; implementation; ODHIN; primary health care; training and support
National Category
Substance Abuse
Identifiers
URN: urn:nbn:se:liu:diva-133116DOI: 10.1111/add.13476ISI: 000386153700010PubMedID: 27237081OAI: oai:DiVA.org:liu-133116DiVA: diva2:1055263
Note

Funding Agencies|European Unions Seventh Framework Programme [259268]; Netherlands Organization for Health Research and Development (ZonMW, Prevention Program) [200310017-ODHIN]; NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Kings College London; NIHR Collaborations for Leadership in Applied Health Research and Care South London at Kings College Hospital NHS Foundation Trust

Available from: 2016-12-12 Created: 2016-12-09 Last updated: 2016-12-12

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Bendtsen, Preben
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Division of Community MedicineFaculty of Medicine and Health SciencesDepartment of Medical Specialist in Motala
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CiteExportLink to record
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