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Anderson, Peter; Bendtsen, Preben; Spak, Fredrik; Reynolds, J.; Drummond, Colin; Segura, Lidia; Keurhorst, Myrna N.; Palacio-vieira, Jorge; Wojnar, Marcin; Parkinson, Kathryn; Colom, Joan; Kłoda, Karolina; Deluca, Paolo; Baena, Begoña; Newbury-Birch, Dorothy; Wallace, Paul; Heinen , Maud; Wolstenholme, Amy; van Steenkiste, Ben; Mierzecki, Artur; Okulicz-Kozaryn, Katarzyna; Ronda, Gaby; Kaner, Eileen; Laurant, Miranda G H; Coulton, Simon; Gual, Toni (2016)
Publisher: John Wiley & Sons
Languages: English
Types: Article
Subjects: HV5001, RA


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 Alcohol Use Disorders Identification Test (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, the Netherlands, Poland and Sweden.

A total of 120 PHCU, 24 in each of Catalonia, England, the 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, 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).

Providing 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.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. World Health Organization. Global status report on alcohol and health 2014. Geneva: World Health Organization, 2014.
    • 2. Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: A systematic review and meta-analysis. Am J Epidemiol. 2010 171:633–44. doi: 10.1093/aje/kwp451.
    • 3. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012 380 2224-60.
    • 4. Kontis V, Mathers, CD, Rehm J, Stevens G A, Shield K D, Bonita R, et al. Contribution of six risk factors to achieving the “25×25” NCD mortality reduction target. Lancet 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60616-4.
    • 5. Emberson JR, Shaper AG, Wannamethee SG et al. Alcohol intake in middle age and risk of cardiovascular disease and mortality: accounting for intake variation over time. Am J Epidemiol 2005 161:856–63.
    • 6. Fillmore KM, Kerr WC, Bostrom A. Changes in drinking status, serious illness and mortality. J Stud Alcohol 2003 64:278–85.
    • 7. Rehm J, Roerecke, M. Reduction of Drinking in Problem Drinkers and All-Cause Mortality. Alcohol and Alcoholism 2013 Vol. 48, No. 4, pp. 509–513.
    • 8. Kaner, EF, Beyer F, Dickinson H, Pienaar E, F FC, Schlesinger C, Heather N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007, 18(2):CD004148.
    • 9. Jonas DE, Garbutt JC, Amick HR, Brown JM, Brownley KA, Council CL, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012;157:645-54. [PMID: 23007881]
    • 10. O’Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, et al. The impact of brief alcohol interventions in primary healthcare: A systematic review of reviews Alcohol and Alcoholism. 2014;49(1):66-78.
    • 11. National Institute for Health and Clinical Excellence. Alcohol-use disorders - preventing the development of hazardous and harmful drinking. http://guidanceniceorguk/PH24. 2010.
    • 12. Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van Ommeren, M et al. Evidence based guidelines for mental, neurological and substance use disorders in low- and middle-income countries: Summary of WHO recommendations. PLOS Medicine, 2011 8 (11), 1-11.
    • 13. Health Scotland (2013). Alcohol Advice 2012/2013. https://isdscotland.scot.nhs.uk/HealthTopics/Drugs-and-Alcohol-Misuse/Publications/2013-06-25/2013-06-25-ABIReport.pdf?89017885924
    • 14. Bendsten, P, Anderson P, Wojnar M, Newbury-Birch D, Müssener, U et al. professional’s attitudes do not influcne screening and brief intervention rates for hazardous and harmful drinkers: results from ODHIN study. Alcohol and Alcoholism 2015 doi: 10.1093/alcalc/agv020
    • 15. Keurhorst M, van de Glind I, Bitarello do Amaral-Sabadini M, Anderson P, Kaner E, NewburyBirch D et al. Determinants of successful implementation of screening and Advice for hazardous and harmful alcohol consumption in primary healthcare. A systematic review and metaregression analysis. Addiction 2015 110:877–900..
    • 16. Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The Effectiveness of Electronic Screening and Intervention for Reducing Levels of Alcohol Consumption: A Systematic Review and Meta-Analysis. (J Med Internet Res 2014;16(6):e142) doi:10.2196/jmir.3193.
    • 17. Keurhorst M, Anderson P, Spak F, Bendtsen P, Segura L, Colom J et al. Implementing training and support, financial reimbursement, and referral to an internet-based 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 2013 8:11. doi:10.1186/1748-5908-8-11.
    • 18. Jonas DE, Garbutt JC, Brown JM, Amick HR, Brownley KA, Council CL, et al. Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse. Comparative Effectiveness Review No. 64. Rockville, MD: Agency for Healthcare Research and Quality; July 2012. Accessed at www.ncbi .nlm.nih.gov/books/NBK99199/ on 16 April 2013.
    • 19. Anderson P, Gual A, Colom J. Alcohol and Primary Health Care: Clinical Guidelines on Identification and Advice In. Barcelona: Department of Health of the Government of Catalonia; 2005.
    • 21. Gual A, Anderson P, Segura L, Colom J. Alcohol and primary health care: Training programme on identification and Advice. Barcelona: department of Health of the Government of Catalonia, 2005.
    • 22. Funk M, Wutzke S, Kaner E, Anderson P, Pas L, McCormick R et al. A multi country controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: Findings of a WHO Collaborative Study. Journal of Studies on Alcohol 2005 66 379-388.
    • 23. Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002; 325:128.
    • 24. Sedgwick P. Randomised controlled trials with full factorial designs. BMJ 2012; 345:e5114.
    • 25. Montgomery AA, Peters TJ, Little P. Design, analysis and presentation of factorial randomised controlled trials. BMC Medical Research Methodology. 2003;3:
    • 26. Rubinsky AD, Dawson DA, Williams EC, Kivlahan DR Bradley KA AUDIT-C Scores as a Scaled Marker of Mean Daily Drinking, Alcohol Use Disorder Severity, and Probability of Alcohol Dependence in a U.S. General Population Sample of Drinkers. Alcoholism: Clinical and Experimental Research 2013 37 1380-1390.
    • 27. Rehm J, Shield KD, Rehm MX, Gmel G, Frick, U. Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: potential gains from effective interventions for alcohol dependence. Toronto, Canada: Centre for Addiction and Mental Health, 2012.
    • 28. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M et al. Attitudes and managing alcohol problems in general practice: an interaction analysis based on Findings from a WHO Collaborative Study. Alcohol and Alcoholism 2004 39:351-356.
    • 29. van Beurden I, Anderson P, Akkermans RP, Grol RP, Wensing M, Laurant MG. Involvement of general practitioners in managing alcohol problems: a randomised controlled trial of a tailored improvement programme. Addiction 2012, 107:1601–1611.
    • 30. Purshouse, R, Brennan, A, Rafia, R Modelling the Cost-Effectiveness of Alcohol Screening and Advice in Primary Care in England. Alcohol Alcohol 2013 48, 180-188.
    • 31. Angus C. Cost-effectiveness of a programme of screening and Advice for alcohol in primary care in Italy. BMC Family PHCU 2014 15:26. doi:10.1186/1471-2296-15-26
    • 32. Health Scotland (2008). H4 ABI: Target and Background Information. http://www.healthscotland.com/documents/3201.aspx.
    • 33. Health Scotland (2011). An evaluation to assess the implementation of NHS delivered Alcohol Brief Interventions: Final Report September 2011. http://www.healthscotland.com/documents/5438.aspx
    • 34. Health Scotland (2011). HEAT Standard: Alcohol Brief Interventions. National Guidance : 2012-13 http://www.healthscotland.com/uploads/documents/17579- ABI%20HEAT%20Standard%20National%20Guidance%202012%20-13%20-%20PDF.pdf
    • 35. Anderson P, Wojnar J, Jakubczyk A, Gual A, Reynolds J, Segura L et al. Managing Alcohol Problems in General Practice in Europe: Results from the European ODHIN Survey of General Practitioners. Alcohol and Alcoholism Vol. 49, No. 5, pp. 531–539.
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