Peter Anderson1,2, Jakob Manthey3,4, Eva Jané Llopis5,6,7, Guillermina Natera Rey8, Ines V Bustamante9, Marina Piazza9, Perla Sonia Medina Aguilar8, Juliana Mejía-Trujillo10, Augusto Pérez-Gómez10, Gill Rowlands11, Hugo Lopez-Pelayo12,13,14, Liesbeth Mercken5, Dasa Kokole5, Amy O'Donnell11, Adriana Solovei5, Eileen Kaner11, Bernd Schulte4, Hein de Vries5, Christiane Schmidt4, Antoni Gual12,13,14, Jürgen Rehm3,7,15,16,17. 1. Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. peter.anderson@maastrichtuniversity.nl. 2. Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. peter.anderson@maastrichtuniversity.nl. 3. Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany. 4. Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. 6. Univ. Ramon Llull, ESADE, Barcelona, Spain. 7. Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada. 8. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico. 9. School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru. 10. Corporación Nuevos Rumbos, Bogotá, Colombia. 11. Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. 12. Addictions Unit, Psychiatry Dept., Hospital Clínic, Barcelona, Spain. 13. Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain. 14. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain. 15. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 16. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 17. Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Abstract
PURPOSE: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. METHODS: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage). RESULTS: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5). CONCLUSIONS: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
PURPOSE: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. METHODS: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage). RESULTS: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5). CONCLUSIONS: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
Keywords:
AUDIT-C; Colombia; Institute for Health Care Improvement; Mexico; Peru; brief advice; heavy drinking; implementation; measurement of alcohol consumption; municipal action; primary health care
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