Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): Study protocol for a cluster randomized factorial trial

Implementation Science (Impact Factor: 4.12). 01/2013; 8(1):11. DOI: 10.1186/1748-5908-8-11
Source: PubMed


The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.

In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.

Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.

Trial registration Trial identifier: NCT01501552

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Available from: Dorothy Newbury-Birch
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    • "Difficulties in persuading GPs and nurses to fully deliver SBI programs could have a substantial impact on the effectiveness and cost-effectiveness of these programs. A recent international trial conducted as part of the optimizing delivery of healthcare interventions (ODHIN) project will go some way to addressing this challenge by examining the effectiveness and cost-effectiveness of different strategies at increasing SBI delivery rates in primary care (43). "
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    ABSTRACT: Introduction: The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. Methods: Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. Results: The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. Conclusion: This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
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    • "where not every GP participates, or not every eligible patient is screened) is an important one for policy makers. The ODHIN project incorporates a major pan-European trial to investigate how different strategies (such as financial incentives or educational programmes) can improve these uptake rates [48] and we plan to utilise the results of this trial in the future to investigate the cost-effectiveness of such strategies as well as partial uptake rates. Finally, whilst the assumption that no patient is screened more than once may not hold true in practice, the published evidence on the effect of repeated brief interventions on alcohol consumption is limited and it is possible that the benefits of such repeat interventions may outweigh the additional costs of their delivery. "
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    ABSTRACT: As alcohol-related health problems continue to rise, the attention of policy-makers is increasingly turning to Screening and Brief Intervention (SBI) programmes. The effectiveness of such programmes in primary healthcare is well evidenced, but very few cost-effectiveness analyses have been conducted and none which specifically consider the Italian context. The Sheffield Alcohol Policy Model has been used to model the cost-effectiveness of government pricing and public health policies in several countries including England. This study adapts the model using Italian data to evaluate a programme of screening and brief interventions in Italy. Results are reported as Incremental Cost-Effectiveness Ratios (ICERs) of SBI programmes versus a 'do-nothing' scenario. Model results show such programmes to be highly cost-effective, with estimated ICERs of [euro sign]550/Quality Adjusted Life Year (QALY) gained for a programme of SBI at next GP registration and [euro sign]590/QALY for SBI at next GP consultation. A range of sensitivity analyses suggest these results are robust under all but the most pessimistic assumptions. This study provides strong support for the promotion of a policy of screening and brief interventions throughout Italy, although policy makers should be aware of the resource implications of different implementation options.
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    ABSTRACT: AimsThe U.S. Veterans Health Administration (VA) used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation.DesignObservational, retrospective cohort study using secondary clinical and administrative data.Setting30 VA facilities.ParticipantsOutpatients who screened positive for unhealthy alcohol use (AUDIT-C ≥ 5) in the 6 months after the brief intervention performance measure (n=22,214) and had follow-up screening 9-15 months later (n=6,210; 28%).MeasurementsMultilevel logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥ 2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking).FindingsAmong 6,210 patients with follow-up alcohol screening, 1,751 (28%) had brief intervention and 2,922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health, and more severe unhealthy alcohol use than those without (p-values <0.05). Adjusted prevalences of resolution were 47% (95% Confidence Interval (CI) 42% - 52%) and 48% (95% CI 42% - 54%) for patients with and without documented brief intervention, respectively (p=0.50).Conclusions During early implementation of brief intervention in the U.S. Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.
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