Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

Preben Bendtsen, Ulrika Müssener, Nadine Karlsson, Hugo López-Pelayo, Jorge Palacio-Vieira, Joan Colom, Antoni Gual, Jillian Reynolds, Paul Wallace, Lidia Segura, Peter Anderson, Preben Bendtsen, Ulrika Müssener, Nadine Karlsson, Hugo López-Pelayo, Jorge Palacio-Vieira, Joan Colom, Antoni Gual, Jillian Reynolds, Paul Wallace, Lidia Segura, Peter Anderson

Abstract

Objectives: The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice.

Design: The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking.

Setting: A total of 120 primary healthcare centres from 5 jurisdictions in Europe.

Participants: 746 individual providers (general practitioners, nurses or other professionals) participated in the study.

Primary outcome: Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period.

Results: The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%.

Conclusions: Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI.

Trial registration number: NCT01501552; Post-results.

Keywords: Alcohol screening; brief intervention; fidelity to intervention; referral to electronic brief advice.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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