GPs’ role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme
Open accessAbstract
BACKGROUND: General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme. METHODS: In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme. RESULTS: Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment. CONCLUSIONS: A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00298220.
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All 5 studies reported that the majority of these professionals were not therapeutically committed.
“All 5 studies reported that the majority of these professionals were not therapeutically committed.”
From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [81]
The Results (Study population, Table 2) report therapeutic-commitment scores for GPs in this study, with a baseline mean of 3.9. The paper does not report that a majority were not therapeutically committed, nor does it report that finding across five studies; a mean alone cannot establish the proportion of GPs below a commitment threshold. (LLM, conf=0.82)
Experimental — accuracy not yet measuredFive quantitative studies employed a validated scale for measuring GPs' and nurses' predisposition for working therapeutically with at-risk drinkers.
“Five quantitative studies (4 on GPs and 1 in both GPs and nurses) employed a validated scale for measuring GPs’ and nurses’ predisposition for working therapeutically with at-risk drinkers [45–47, 50, 81].”
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- Authors
- Keurhorst, M., van Beurden, I., Anderson, P., Heinen, M., Akkermans, R., Wensing, M., & Laurant, M.
- Affiliations
- Radboud University Medical Center (NL)
- Newcastle University (GB)
- HAN University of Applied Sciences (NL)
- Corresponding author
- Keurhorst, Myrna
- Venue
- BMC Family Practice
- Published
- 2014-04-17
- Volume
- 15
- Issue
- 1
- Pages
- 70-70
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC4021502
- OpenAlex
- W2011266702
- Cited by
- 15
- References
- 35
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 1 · 2021: 6 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 2
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Family Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- ZonMw (63000003)
- Trimbos-instituut
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- general practitioners, therapeutic commitment, alcohol-related problems, hazardous drinking, implementation program, alcohol screening, primary care, guideline implementation
- MeSH terms
- Adult, Alcohol Drinking, Attitude of Health Personnel, Female, Health Plan Implementation, Humans, Male, Middle Aged, Models, Theoretical, Netherlands, Practice Patterns, Physicians', Social Support, Program Evaluation, Cluster Analysis, Treatment Outcome, Practice Guidelines as Topic, Professional Role, Directive Counseling, General Practitioners, Motivational Interviewing
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