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: Alcohol brief advice in primary health care
Open accessAbstract
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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- Authors
- Anderson, P., Bendtsen, P., Spak, F., Reynolds, J., Drummond, C., Segura, L., Keurhorst, M. N., Palacio-Vieira, J., Wojnar, M., Parkinson, K., Colom, J., Kłoda, K., Deluca, P., Baena, B., Newbury-Birch, D., Wallace, P., Heinen, M., Wolstenholme, A., van Steenkiste, B., Mierzecki, A., Okulicz-Kozaryn, K., Ronda, G., Kaner, E., Laurant, M. G. H., Coulton, S., & Gual, T.
- Affiliations
- Maastricht University (NL)
- Linköping University (SE)
- University of Gothenburg (SE)
- Hospital Clínic de Barcelona (ES)
- King's College London (GB)
- Program on Substance Abuse, Public Health Agency; Government of Catalonia; Barcelona Spain
- Radboud University Medical Center (NL)
- Medical University of Warsaw (PL)
- Newcastle University (GB)
- Generalitat de Catalunya (ES)
- Pomeranian Medical University (PL)
- Institute of Health and Society; Newcastle University; Newcastle UK
- University College London (GB)
- Department of Family Medicine; Maastricht University; Maastricht the Netherlands
- State Agency for Prevention of Alcohol-Related Problems; Warsaw Poland
- HAN University of Applied Sciences (NL)
- University of Kent (GB)
- Corresponding author
- Anderson, Peter
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2016-07-25
- Volume
- 111
- Issue
- 11
- Pages
- 1935-1945
- ISSN
- 0965-2140 (ISSN-L)
- OpenAlex
- W2499038067
- Cited by
- 98
- References
- 28
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 10 · 2021: 19 · 2020: 7 · 2019: 8 · 2018: 5 · 2017: 19 · 2016: 6 · 2015: 1
- FWCI
- 23.56
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- TeesRep (Teesside University) (acceptedVersion, cc-by-nc-nd)
- Kent Academic Repository (University of Kent) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Teesside University Research Portal (Teesside University) (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- European Union's Seventh Framework Programme (259268)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- health care, brief intervention, heavy drinking, alcohol screening, AUDIT-C, reimbursement, EBI, screening program implementation, alcoholism, primary care providers, screening uptake, Catalonia, England, Netherlands, Poland, Sweden, cost-effectiveness
- MeSH terms
- Alcohol Drinking, Alcoholism, Counseling, Delivery of Health Care, Female, Humans, Male, Middle Aged, Motivation, Patient Education as Topic, Primary Health Care, Psychotherapy, Brief, Cluster Analysis, Internet, Early Diagnosis
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