Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial.

Centre for Health Services Research, 21 Claremont Place, University of Newcastle upon Tyne, NE2 4AA, UK.
Patient Education and Counseling (Impact Factor: 2.6). 12/2003; 51(3):277-84. DOI: 10.1016/S0738-3991(02)00242-2
Source: PubMed

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.

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    ABSTRACT: Despite the increasing popularity of screening and brief intervention (SBI) for hazardous drinking within the wider population, there is a paucity of SBI research directed at Indigenous populations. In Canada, Aboriginal drinkers are less than half as likely to drink on a weekly/daily basis but more than twice as likely to binge drink compared to the general drinking population. As a result, there is a high rate of alcohol related deaths and hospitalisations compared to the non-Aboriginal population. Modification of these patterns and levels of hazardous drinking – especially binge drinking – among Aboriginal drinkers should markedly improve health outcomes. Although the efficacy of SBI has been demonstrated across a range of health care settings and sociocultural groups, there are potential systemic and cultural barriers to implementation of SBI for Aboriginal hazardous drinkers including the historic impact of alcohol on Aboriginal communities. Implementation of SBI must address these barriers and be sensitive to the historic relationship between Aboriginals and alcohol.
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