Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial.
ABSTRACT This trial evaluated the clinical impact and cost-effectiveness of strategies promoting screening and brief alcohol intervention (SBI) by nurses in primary care. Randomisation was at the level of the practice and the interventions were: written guidelines (controls, n=76); outreach training (n=68); and training plus telephone-based support (n=68). After 3 months, just 39% of controls implemented the SBI programme compared to 74% of nurses in trained practices and 71% in trained and supported practices. Controls also screened fewer patients and delivered fewer brief interventions to risk drinkers than other colleagues. However, there was a trade-off between the extent and the appropriateness of brief intervention delivery with controls displaying the least errors in overall patient management. Thus cost-effectiveness ratios (cost per patient appropriately treated) were similar between the three strategies. Given the potential for anxiety due to misdirected advice about alcohol-related risk, the balance of evidence favoured the use of written guidelines to promote SBI by nurses in primary care.
- SourceAvailable from: Catherine A Haighton[show abstract] [hide abstract]
ABSTRACT: Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs. This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited. The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi-structured in-depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North-east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions. As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.Journal of Advanced Nursing 09/2002; 39(4):333-42. · 1.53 Impact Factor
- Public Health Nursing 04/1988; 5(1):16-23. · 0.78 Impact Factor
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ABSTRACT: Although there has been growing interest in general practitioners' participation in promoting health, little is known about the attitudes of their patients. Thus we sent a copy of a self administered questionnaire (the Health Survey Questionnaire) to 3452 patients aged 17-70 who were registered with two practices in north west London. Questions about attitudes to and perceptions of general practitioners' interest in weight, smoking, drinking, and fitness problems were included. The patients were also asked whether they thought that they had a problem in any of these areas. The response rate was 72%. Of those who responded, the proportions who thought that their general practitioners should be interested ranged from 72% in the case of fitness to 83% for weight, but only 38% thought that general practitioners had in fact been interested in fitness and only 48% thought so about weight. Forty one per cent of the respondents thought that they had a fitness problem, 42% a weight problem, and 59% of the smokers thought that they had a smoking problem. Four per cent of respondents stated that they had a drinking problem. Of those patients who said that they had a problem, the proportions who thought that their general practitioners had seemed interested ranged from 43% for fitness to 69% for smoking. The findings of this study suggest that greater participation by general practitioners in health promotion would be well received by most patients and that currently there may be considerable discrepancies between patients' expectations and their perception of their general practitioner's interest in these areas of preventive medicine.British medical journal (Clinical research ed.) 10/1984; 289(6444):534-6.