Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

Peter Anderson, Jakob Manthey, Eva Jané Llopis, Guillermina Natera Rey, Ines V Bustamante, Marina Piazza, Perla Sonia Medina Aguilar, Juliana Mejía-Trujillo, Augusto Pérez-Gómez, Gill Rowlands, Hugo Lopez-Pelayo, Liesbeth Mercken, Dasa Kokole, Amy O'Donnell, Adriana Solovei, Eileen Kaner, Bernd Schulte, Hein de Vries, Christiane Schmidt, Antoni Gual, Jürgen Rehm, Peter Anderson, Jakob Manthey, Eva Jané Llopis, Guillermina Natera Rey, Ines V Bustamante, Marina Piazza, Perla Sonia Medina Aguilar, Juliana Mejía-Trujillo, Augusto Pérez-Gómez, Gill Rowlands, Hugo Lopez-Pelayo, Liesbeth Mercken, Dasa Kokole, Amy O'Donnell, Adriana Solovei, Eileen Kaner, Bernd Schulte, Hein de Vries, Christiane Schmidt, Antoni Gual, Jürgen Rehm

Abstract

Purpose: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured.

Methods: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage).

Results: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5).

Conclusions: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions.

Trial registration: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://ichgcp.net/clinical-trials-registry/NCT03524599.

Keywords: AUDIT-C; Colombia; Institute for Health Care Improvement; Mexico; Peru; brief advice; heavy drinking; implementation; measurement of alcohol consumption; municipal action; primary health care.

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Average cumulative coverage at month 5 for each exposure group, as defined by each hypothesis (points indicate mean and vertical lines indicate mean ± one standard deviation).

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