Peter Anderson1,2, Preben Bendtsen3, Fredrik Spak4, Jillian Reynolds5, Colin Drummond6,7, Lidia Segura8, Myrna N Keurhorst9, Jorge Palacio-Vieira8, Marcin Wojnar10, Kathryn Parkinson11, Joan Colom8, Karolina Kłoda12, Paolo Deluca6, Begoña Baena8, Dorothy Newbury-Birch11, Paul Wallace13, Maud Heinen9, Amy Wolstenholme6, Ben van Steenkiste14, Artur Mierzecki12, Katarzyna Okulicz-Kozaryn15, Gaby Ronda14, Eileen Kaner11, Miranda G H Laurant9,16, Simon Coulton17, Toni Gual5. 1. Institute of Health and Society, Newcastle University, Newcastle, UK. peter.anderson@newcastle.ac.uk. 2. Department of Family Medicine, Maastricht University, Maastricht, the Netherlands. peter.anderson@newcastle.ac.uk. 3. Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden. 4. Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden. 5. Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain. 6. National Addiction Centre, Institute of Psychiatry, King's College London, London, UK. 7. National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK. 8. Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain. 9. Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands. 10. Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland. 11. Institute of Health and Society, Newcastle University, Newcastle, UK. 12. Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland. 13. Research Department of Primary Care and Population Health, University College London, London, UK. 14. Department of Family Medicine, Maastricht University, Maastricht, the Netherlands. 15. State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland. 16. HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands. 17. Centre for Health Service Studies, University of Kent, Canterbury, UK.
Abstract
AIM: 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. DESIGN: Cluster randomized factorial trial with 12-week implementation and measurement period. SETTING: Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. PARTICIPANTS: A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. INTERVENTIONS: 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. MEASUREMENTS: 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. FINDINGS: 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). CONCLUSIONS: 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.
AIM: 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. DESIGN: Cluster randomized factorial trial with 12-week implementation and measurement period. SETTING: Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. PARTICIPANTS: A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. INTERVENTIONS: 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. MEASUREMENTS: 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. FINDINGS: 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). CONCLUSIONS: 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.
Authors: Peter Anderson; Simon Coulton; Eileen Kaner; Preben Bendtsen; Karolina Kłoda; Jillian Reynolds; Lidia Segura; Marcin Wojnar; Artur Mierzecki; Paolo Deluca; Dorothy Newbury-Birch; Kathryn Parkinson; Katarzyna Okulicz-Kozaryn; Colin Drummond; Antoni Gual Journal: Ann Fam Med Date: 2017-07 Impact factor: 5.166
Authors: M Keurhorst; P Anderson; M Heinen; Preben Bendtsen; Begoña Baena; Krzysztof Brzózka; Joan Colom; Paolo Deluca; Colin Drummond; Eileen Kaner; Karolina Kłoda; Artur Mierzecki; Dorothy Newbury-Birch; Katarzyna Okulicz-Kozaryn; Jorge Palacio-Vieira; Kathryn Parkinson; Jillian Reynolds; Gaby Ronda; Lidia Segura; Luiza Słodownik; Fredrik Spak; Ben van Steenkiste; Paul Wallace; Amy Wolstenholme; Marcin Wojnar; Antoni Gual; M Laurant; M Wensing Journal: Implement Sci Date: 2016-07-16 Impact factor: 7.327
Authors: Preben Bendtsen; Ulrika Müssener; Nadine Karlsson; Hugo López-Pelayo; Jorge Palacio-Vieira; Joan Colom; Antoni Gual; Jillian Reynolds; Paul Wallace; Lidia Segura; Peter Anderson Journal: BMJ Open Date: 2016-06-16 Impact factor: 2.692
Authors: Jürgen Rehm; Jose Angel Arbesu Prieto; Markus Beier; Didier Duhot; Alessandro Rossi; Bernd Schulte; José Zarco; Henri-Jean Aubin; Michael Bachmann; Carsten Grimm; Ludwig Kraus; Jakob Manthey; Emanuele Scafato; Antoni Gual Journal: BMC Fam Pract Date: 2016-09-08 Impact factor: 2.497
Authors: Peter Anderson; Karolina Kłoda; Eileen Kaner; Jillian Reynolds; Preben Bendtsen; Myrna N Pelgrum-Keurhorst; Lidia Segura; Marcin Wojnar; Artur Mierzecki; Paolo Deluca; Dorothy Newbury-Birch; Kathryn Parkinson; Katarzyna Okulicz-Kozaryn; Colin Drummond; Miranda G H Laurant; Antoni Gual Journal: Eur J Gen Pract Date: 2017-12 Impact factor: 1.904