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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

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Peter Anderson, Preben Bendtsen, Fredrik Spak, J. Reynolds, Colin Drummond, Lidia Segura, Myrna N. Keurhorst, Jorge Palacio-vieira, Marcin Wojnar, Kathryn Parkinson, Joan Colom, Karolina Kłoda, Paolo Deluca, Begoña Baena, Dorothy Newbury-Birch, Paul Wallace, Maud Heinen , Amy Wolstenholme, Ben van Steenkiste, Artur Mierzecki & 6 more Katarzyna Okulicz-Kozaryn, Gaby Ronda, Eileen Kaner, Miranda G H Laurant, Simon Coulton, Toni Gual

Original languageEnglish
Pages (from-to)1935–1945
Number of pages10
JournalAddiction
Volume111
Issue number11
Early online date25 Jul 2016
DOIs
Accepted/In press25 May 2016
E-pub ahead of print25 Jul 2016
PublishedNov 2016

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Abstract

Aim

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.
Design

Cluster randomized factorial trial with 12-week implementation and measurement period.
Setting

Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.
Participants

A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.

Interventions
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.

Measurements
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.

Findings
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).

Conclusions
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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