Screening and brief intervention targeting risky drinkers in Danish general practice - a pragmatic controlled trial
Abstract
AIMS: Recommendations for routine alcohol screening and brief counselling intervention in primary health care rest on results from intervention efficacy studies. By conducting a pragmatic controlled trial (PCT), we aimed at evaluating the effectiveness of the WHO recommendations for screening and brief intervention (SBI) in general practice. METHODS: A randomized PCT (brief counselling intervention vs no intervention) involving 39 Danish general practitioners (GPs). Systematic screening of 6897 adults led to inclusion of 906 risky drinkers, and research follow-up on 537 of these after 12-14 months. Outcome measures focused on patients' acceptance of screening and intervention and their self-reported alcohol consumption. RESULTS: Patient acceptance of screening and intervention -10.3% (N = 794) of the target population (N = 7, 691) explicitly refused screening. All intervention group subjects (N = 442) were exposed to an instant brief counselling session while only 17.9% of them (79/442) attended a follow-up consultation that was offered by their GP. Consumption Changes At one-year follow-up, average weekly consumption had increased by 0.7 drinks in both comparison groups. As secondary findings, we observed an indiscriminate absolute risk reduction (ARR = 0.08 (95% CI: -0.02; 0.18)) in male binge drinking, but adverse intervention effects for women on the secondary outcomes (binge drinking ARR = -0.30 (95% CI: -0.47; -0.09)). CONCLUSIONS: The results of brief interventions in everyday general practice performed on the basis of systematic questionnaire screening may fall short of theoretical expectations. When applied to non-selected groups in everyday general practice SBI may have little effect and engender diverse outcome. Women may be more susceptible to defensive reactions than men.
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Of these 51 studies, 27 reported quantity and corresponding standard deviation at 12 months.
“Of these, 27 studies reported quantity and corresponding standard deviation at 12 months (Altisent 1997;Beich 2007;Bernstein 2010;Blow 2006;Córdoba 1998;Crawford 2004;Daeppen 2007;D'Onofrio 2008;D'Onofrio 2012;Drummond 2014;Fleming 1997;Fleming 1999;Fleming 2004;Fleming 2010;Helstrom 2014;Kaner 2013;Lock 2006;Maisto 2001;Richmond 1995;Rubio 2010;Schaus 2009;Scott 1990;Senft 1997;Soderstrom 2007;”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Three trials (4%) were at high risk of detection bias because the outcome assessor was not blinded.
“We assessed three trials (4%) to be at high risk of detection bias because they stated that the outcome assessor was not blinded (Beich 2007;Dent 2008;Segatto 2011).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had low risk of bias for allocation concealment.
“Allocation concealment (selection bias) Low risk Screening questionnaires went into a sealed envelope which had a symbol on the front which had to be uncovered scratch card style (p.594)”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had unclear risk of bias for random sequence generation.
“Random sequence generation (selection bias) Unclear risk Sequence generation not described.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had high risk of bias for blinding of treatment providers.
“Blinding of treatment providers High risk”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 used intention-to-treat analysis.
“ITT: yes.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had high risk of bias for blinding of outcome assessment.
“Blinding of outcome assessment (detection bias) All outcomes High risk Blinding was not feasible, either for participants and GPs, or for outcome assessment and statistical analysis”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had low risk of bias for selective reporting.
“Selective reporting (reporting bias) Low risk Outcomes specified in methods were reported in results.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had high risk of bias for incomplete outcome data.
“Incomplete outcome data (attrition bias) All outcomes High risk Loss to follow-up > 30%.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
Beich 2007 had high risk of bias for blinding of participants.
“Blinding of participants High risk”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Beich 2007
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- Authors
- Beich, A., Gannik, D., Saelan, H., & Thorsen, T.
- Affiliations
- University of Copenhagen (DK)
- Copenhagen Municipality (DK)
- Corresponding author
- Beich, Anders
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-09-11
- Volume
- 42
- Issue
- 6
- Pages
- 593-603
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W2139580845
- Semantic Scholar
- 3dd2e6031bd04d1e1f34fe42e732fa9e4a914742
- Cited by
- 41
- References
- 52
- Citations by year
- 2022: 2 · 2021: 5 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 5
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- alcohol screening, brief intervention, hazardous drinking, general practice, primary care, binge drinking, alcohol consumption, intervention effectiveness, sex differences, defensive reactions, WHO guidelines
- MeSH terms
- Adolescent, Adult, Alcohol Drinking, Alcoholism, Denmark, Family Practice, Female, Follow-Up Studies, Humans, Male, Mass Screening, Middle Aged, Physician's Role, Risk Factors
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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