Impact of Training and Municipal Support on Primary Health Care–Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

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

Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America

“…irrespective of drinking status) was unaffected by either the presence of community support or the intensity of the clinical package, rates were higher amongst those providers who had received training. These latter findings are consistent with our five-month alcohol-related outcome results, where we found that participating in training increased the proportion of patients whose alcohol consumption was measured [ 48 ].…”

“…Thus, although training had no direct impact on the proportion of patients with an AUDIT-C score of 8+ assessed for depression, we found an indirect impact of training on the overall proportion of patients assessed for depression. Moreover, as we found non-superiority of the standard package, we conclude that the shorter less intense package can be implemented as the norm [ 48 ].…”

“…Training sessions lasted between two and four hours and were delivered by existing country-based trainers who had previously attended a SCALA-specific train-the trainers-programme. Over 70 percent of providers attended at least one training session (72.3%), with a higher rate reported for Arms 2 and 4 (74.1% and 76.9% respectively) compared to Arm 3 (66.3%) [see 48 ]. During the implementation period, booster training sessions were offered, which included summary reminders of key concepts and the care pathway process alongside tailored ‘troubleshooting’ based on providers’ experience to date.…”

“…In this paper, we present results of the first interim evaluation (planned for month six but brought forward to month five due to the impact of the COVID-19 pandemic) for our secondary outcomes: 1) proportion of patients identified as heavy drinkers who are also screened for depression; 2) proportion of patients screened positive for depression receiving advice and/or treatment for comorbid depression; and 3) proportion of all consulting patients screened for depression, irrespective of drinking status. Results for our primary outcomes, rates of measurement of alcohol consumption of PHC patients and proportion of heavy drinking patients receiving support, are reported elsewhere [ 48 ].…”

Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption

“…In the international SCALA study, we drew on the model developed by Barker and colleagues (2015) to design and evaluate the impact of supportive actions developed together with local community stakeholders (henceforth: community support) on alcohol measurement in a PHC setting, in three Latin American countries (Jané-Llopis et al, 2020). Interim results are reported elsewhere (Anderson et al, 2021) and show that when analysing changes at the level of the PHC centres (PHCCs), no effects were found of community support on provision of the intervention. A possible reason for the lack of effects was the shorter implementation time of the SCALA project than initially planned (5 months vs. 18 months), due to COVID-19 restrictions.…”