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 factorial trial
Por:
Anderson, P, Bendtsen, P, Spak, F, Reynolds, J, Drummond, C, Segura, L, Keurhorst, MN, Palacio-Vieira, J, Wojnar, M, Parkinson, K, Colom, J, Kloda, K, Deluca, P, Baena, B, Newbury-Birch, D, Wallace, P, Heinen, M, Wolstenholme, A, van Steenkiste, B, Mierzecki, A, Okulicz-Kozaryn, K, Ronda, G, Kaner, E, Laurant, MGH, Coulton, S, Gual, T
Publicada:
1 nov 2016
Resumen:
AimTo 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 Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.
DesignCluster randomized factorial trial with 12-week implementation and measurement period.
SettingPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.
ParticipantsA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.
InterventionsPHCUs 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.
MeasurementsThe 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.
FindingsDuring a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI=1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI=1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI=1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI=1.11-2.53).
ConclusionsProviding primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-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.
Filiaciones:
Anderson, P:
Newcastle Univ, Inst Hlth & Soc, Newcastle, England
Maastricht Univ, Dept Family Med, Maastricht, Netherlands
Bendtsen, P:
Linkoping Univ, Dept Med Specialist, Linkoping, Sweden
Linkoping Univ, Dept Med & Hlth, Linkoping, Sweden
Spak, F:
Univ Gothenburg, Dept Social Med, Gothenburg, Sweden
Reynolds, J:
Hosp Clin Barcelona, Inst Clin Neurosci, Barcelona, Spain
Drummond, C:
Kings Coll London, Inst Psychiat, Natl Addict Ctr, London, England
South London & Maudsley NHS Fdn Trust, Natl Inst Hlth Res, Biomed Res Ctr Mental Hlth, London, England
Segura, L:
Govt Catalonia, Program Subst Abuse, Publ Hlth Agcy, Barcelona, Spain
Keurhorst, MN:
Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Sci Inst Qual Healthcare IQ Healthcare, Med Ctr, Nijmegen, Netherlands
Palacio-Vieira, J:
Govt Catalonia, Program Subst Abuse, Publ Hlth Agcy, Barcelona, Spain
Wojnar, M:
Med Univ Warsaw, Dept Psychiat, Warsaw, Poland
Parkinson, K:
Newcastle Univ, Inst Hlth & Soc, Newcastle, England
Colom, J:
Govt Catalonia, Program Subst Abuse, Publ Hlth Agcy, Barcelona, Spain
Kloda, K:
Pomeranian Med Univ, Independent Lab Family Phys Educ, Szczecin, Poland
Deluca, P:
Kings Coll London, Inst Psychiat, Natl Addict Ctr, London, England
Baena, B:
Govt Catalonia, Program Subst Abuse, Publ Hlth Agcy, Barcelona, Spain
Newbury-Birch, D:
Newcastle Univ, Inst Hlth & Soc, Newcastle, England
Wallace, P:
UCL, Res Dept Primary Care & Populat Hlth, London, England
Heinen, M:
Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Sci Inst Qual Healthcare IQ Healthcare, Med Ctr, Nijmegen, Netherlands
Wolstenholme, A:
Kings Coll London, Inst Psychiat, Natl Addict Ctr, London, England
van Steenkiste, B:
Maastricht Univ, Dept Family Med, Maastricht, Netherlands
Mierzecki, A:
Pomeranian Med Univ, Independent Lab Family Phys Educ, Szczecin, Poland
Okulicz-Kozaryn, K:
State Agcy Prevent Alcohol Related Problems, Warsaw, Poland
Ronda, G:
Maastricht Univ, Dept Family Med, Maastricht, Netherlands
Kaner, E:
Newcastle Univ, Inst Hlth & Soc, Newcastle, England
Laurant, MGH:
Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Sci Inst Qual Healthcare IQ Healthcare, Med Ctr, Nijmegen, Netherlands
HAN Univ Appl Sci, Fac Hlth & Social Studies, Nijmegen, Netherlands
Coulton, S:
Univ Kent, Ctr Hlth Serv Studies, Canterbury, Kent, England
Gual, T:
Hosp Clin Barcelona, Inst Clin Neurosci, Barcelona, Spain
Green Submitted, Green Accepted
|