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: Miranda GH Laurant
[Show abstract] [Hide abstract]
- "There are studies that already evaluated the effects of nurses’ SBI (e.g. [33-35]), this research could be extended with evaluating task substitution from the GP to the nurse. "
ABSTRACT: 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. 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. 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. 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.BMC Family Practice 04/2014; 15(1):70. DOI:10.1186/1471-2296-15-70 · 1.74 Impact Factor
- "Hur mycket rödvin kunde/borde man dricka för att det var nyttigt? Förvirringen gjorde att det var svårt att ge råd och stöd (Lock et al., 2002:1). Kunskaper om identifikationen av riskbruk verkade vara bättre än kunskapen om kort intervention (Johansson et al., 2000). "
[Show abstract] [Hide abstract]
- "A blinded analysis was reported in only one study . The most frequently used outcome measure was BI rate (measured in 10 of the 11 studies) [29Á/32,34 Á/39], followed by screening rate (9 studies ) [30 Á/32,34 Á/39], and material utilization rate (five studies)     . The primary data sources were questionnaire self-reports and selfmonitoring reports of BI activity by the PHC personnel. "
ABSTRACT: To review systematically the available literature on implementation of brief alcohol interventions in primary healthcare in order to determine the effectiveness of the implementation efforts by the health are providers. KEY QUESTION: To what extent have the efforts to implement brief alcohol interventions in primary healthcare environments been successful? Literature search from Medline, Cinahl, PsychLIT, Cochrane. Primary healthcare. A total of 11 studies encompassing 921 GPs, 266 nurses, 88 medical students, and 44 "non-physicians" from Europe, the USA, and Australia. Material utilization, screening, and brief intervention rates. Intervention effectiveness (material utilization, screening, and brief intervention rates) generally increased with the intensity of the intervention effort, i.e. the amount of training and/or support provided. Nevertheless, the overall effectiveness was rather modest. However, the studies examined were too heterogeneous, not scientifically rigorous enough, and applied too brief follow-up times to provide conclusive answers.Scandinavian Journal of Primary Health Care 04/2006; 24(1):5-15. DOI:10.1080/02813430500475282 · 1.61 Impact Factor