Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five‐country cluster randomized…

Peter Anderson, Preben Bendtsen, Fredrik Spak, Jillian Reynolds, Colin Drummond, Lidia Segura, Myrna N. Keurhorst, Jorge Palacio‐Vieira, Marcin Wojnar, Kathryn Parkinson, Joan Colom, Karolina Kłoda, Paolo Deluca, Begoña Baena, Dorothy Newbury‐Birch, Paul Wallace, Maud Heinen, Amy Wolstenholme, Ben van Steenkiste, Artur Mierzecki, Katarzyna Okulicz‐Kozaryn, Gaby Ronda, Eileen Kaner, Miranda G. H. Laurant, Simon Coulton, Toni Gual

To test if training and support, financial reimbursement, and option of referring screen positive patients to an internet-based method of giving advice (eBI) can increase primary health care providers' delivery of AUDIT-C based screening and advice to heavy drinkers. Cluster randomized factorial trial with 12-week implementation and measurement period. Primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden. 120 PHCU, 24 in each of Catalonia, England, Netherlands, Poland and Sweden. PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR), and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen positive patients advised; and, proportion of consulting adult patients given an intervention (screening and advice to screen positives) during the same 12-week implementation period. During a 4-week baseline measurement period, 5.9 (95% CI 3.4 to 8.4) per 100 adult patients consulting per PHCU were screened for their alcohol consumption. Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI 1.13 to 1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was2.00 (95% CI 1.56 to 2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was2.34 (95% CI 1.77 to 3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI 1.11 to 2.53). Providing primary health care units with training, support and financial reimbursement for delivering AUDIT-C based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health care units with the option of referring screen positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption. (†) Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.