GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme

Myrna Keurhorst, Ivonne van Beurden, Peter Anderson, Maud Heinen, Reinier Akkermans, Michel Wensing, Miranda Laurant, Myrna Keurhorst, Ivonne van Beurden, Peter Anderson, Maud Heinen, Reinier Akkermans, Michel Wensing, Miranda Laurant

Abstract

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.

Figures

Figure 1
Figure 1
Participant flow.

References

    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380:2224–2260.
    1. World Health Organization. Alcohol in the European Union. Consumption, Harm and Policy Approaches. In: Anderson P, Møller L, Galea G, editor. Alcohol in the European Union. Consumption, harm and policy approaches. Copenhagen: WHO Regional office for Europe; 2012.
    1. Anderson P, Baumberg B. Alcohol in Europe. London: Institute of Alcohol Studies; 2006.
    1. Hilbink M, Voerman G, van Beurden I, Penninx B, Laurant M. A randomized controlled trial of a tailored primary care program to reverse excessive alcohol consumption. J Am Board Fam Med. 2012;25:712–722. doi: 10.3122/jabfm.2012.05.120070.
    1. Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007. p. Art. no.: CD000409. doi:10.1002/14651858.CD000409.pub2.
    1. Babor TF, Higgins-Biddle JC. Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction. 2000;95:677–686. doi: 10.1046/j.1360-0443.2000.9556773.x.
    1. Anderson P. In: Prevention of Cardiovascular Disease: An Evidence-Based Approach. Volume 2. Lawrence M, Neil A, Fowler G, Mant D, editor. Oxford: Oxford University Press; 1996. The Effectiveness of General practitioners’ Advice in Reducing the Risk of Alcohol.
    1. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Med Care. 2000;38:7–18. doi: 10.1097/00005650-200001000-00003.
    1. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002;26:36–43. doi: 10.1111/j.1530-0277.2002.tb02429.x.
    1. Ernst D, Miller WR, Rollnick S. Treating substance abuse in primary care: a demonstration project. Int J Integr Care. 2007;7:e36.
    1. Spandorfer JM, Israel Y, Turner BJ. Primary care physicians’ views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999;48:899–902.
    1. Anderson P. Overview of interventions to enhance primary-care provider management of patients with substance-use disorders. Drug Alcohol Rev. 2009;28:567–574. doi: 10.1111/j.1465-3362.2009.00113.x.
    1. Kaner EF, Heather N, McAvoy BR, Lock CA, Gilvarry E. Intervention for excessive alcohol consumption in primary health care: attitudes and practices of english general practitioners. Alcohol Alcohol. 1999;34:559–566. doi: 10.1093/alcalc/34.4.559.
    1. Babor TE, Higgins-Biddle J, Dauser D, Higgins P, Burleson JA. Alcohol screening and brief intervention in primary care settings: implementation models and predictors. J Stud Alcohol. 2005;66:361–368.
    1. Nilsen P. Brief alcohol intervention–where to from here? Challenges remain for research and practice. Addiction. 2010;105:954–959. doi: 10.1111/j.1360-0443.2009.02779.x.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Dec. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. De Vries H, Mudde AN, Leijs I, Charlton A, Vartiainen E, Buijs G, Clemente MP, Storm H, Gonzalez Navarro A, Nebot M, Prins T, Kremers S. The European smoking prevention framework approach (ESFA): an example of integral prevention. Health Educ Res. 2003;18:611–626. doi: 10.1093/her/cyg031.
    1. De Vries H. In: Gezondheidsvoorlichting en Gedragsverandering. Health Education and Behavioural Change. Damoiseaux V, Van der Molen HT, Kok GJ, editor. Assen: Van Gorcum; 1993. Determinanten van Gedrag [Determinants of Behaviour] pp. 109–132.
    1. Shaw S, Cartwright A, Spratley T, Harwin J. Responding to Drinking Problems. London: Croom Helm; 1978.
    1. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, Grol R, Gual A, Pas L. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39:351–356. doi: 10.1093/alcalc/agh072.
    1. McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–972. doi: 10.1007/BF02743146.
    1. Funk M, Wutzke S, Kaner E, Anderson P, Pas L, McCormick R, Gual A, Barfod S, Saunders J. A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a world health organization collaborative study. J Stud Alcohol. 2005;66:379–388.
    1. van Beurden I, Anderson P, Akkermans RP, Grol RP, Wensing M, Laurant MG. Involvement of general practitioners in managing alcohol problems: a randomised controlled trial of a tailored improvement programme. Addiction. 2012;107:1601–1611. doi: 10.1111/j.1360-0443.2012.03868.x.
    1. Meerkerk GJ, Aarns T, Dijkstra RH, Weisscher P, Njoo K, Boomsma LJ. NHG-standaard problematisch alcoholgebruik (tweede herziening) Huisarts Wet. 2005;48:284–285.
    1. Anderson P, Clement S. The AAPPQ revisited: the measurement of general practitioners’ attitudes to alcohol problems. Br J Addict. 1987;82:753–759. doi: 10.1111/j.1360-0443.1987.tb01542.x.
    1. Dinh P. Using multiple imputation to estimate cumulative distribution functions in longitudinal data analysis with data missing at random. Pharm Stat. 2013;12:260–267. doi: 10.1002/pst.1579. doi: 210.1002/pst.1579. Epub 2013 Jul 1004.
    1. Butler CC, Simpson SA, Hood K, Cohen D, Pickles T, Spanou C, McCambridge J, Moore L, Randell E, Alam MF, Kinnersley P, Edwards A, Smith C, Rollnick S. Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial. BMJ. 2013;346:f1191. doi: 10.1136/bmj.f1191.
    1. Franke L, Kommers T, Van Weel E, Lucasson P, Beek M, Van den Hoogen H, Van Weel C. General practice registrars and research - attitudes toward participation. Aust Fam Physician. 2008;37:276–279.
    1. Leathem CS, Cupples ME, Byrne MC, O’Malley M, Houlihan A, Murphy AW, Smith SM. Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care. BMC Med Res Methodol. 2009;9:40. doi: 10.1186/1471-2288-9-40.
    1. van der Wouden JC, Blankenstein AH, Huibers MJ, van der Windt DA, Stalman WA, Verhagen AP. Survey among 78 studies showed that Lasagna’s law holds in dutch primary care research. J Clin Epidemiol. 2007;60:819–824. doi: 10.1016/j.jclinepi.2006.11.010.
    1. Veitch C, Hollins J, Worley P, Mitchell G. General practice research. Problems and solutions in participant recruitment and retention. Aust Fam Physician. 2001;30:399–406.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48. doi: 10.4278/0890-1171-12.1.38.
    1. Kaner E, Lock C, Heather N, McNamee P, Bond S. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Patient Educ Couns. 2003;51:277–284. doi: 10.1016/S0738-3991(02)00242-2.
    1. McElwaine KM, Freund M, Campbell EM, Slattery C, Wye PM, Lecathelinais C, Bartlem KM, Gillham KE, Wiggers JH. Clinician assessment, advice and referral for multiple health risk behaviors: prevalence and predictors of delivery by primary health care nurses and allied health professionals. Patient Educ Couns. 2013;94(2):193–201.
    1. Reiff-Hekking S, Ockene JK, Hurley TG, Reed GW. Brief physician and nurse practitioner-delivered counseling for high-risk drinking: results at 12-month follow-up. J Gen Intern Med. 2005;20(1):7–13. doi: 10.1111/j.1525-1497.2005.21240.x.

Source: PubMed

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