Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial

Abstract

Purpose: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool.

Methods: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months.

Results: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention.

Conclusions: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

Trial registration: ClinicalTrials.gov NCT01501552.

Keywords: electronic brief intervention; financial reimbursement; heavy drinking; implementation study; practice-based research; primary health care; training and support.

Conflict of interest statement

Conflicts of interest: Dr Gual reports grants and personal fees from Lundbeck and D&A Pharma, grants from Teva, and personal fees from AbbVie, outside the submitted work. The other authors report having no conflicts of interest.

© 2017 Annals of Family Medicine, Inc.

Figures

Figure 1

Flow chart of primary health care units in the trial. eBI=electronic brief intervention/advice; FR=financial reimbursement; TS=training and support.