Implementation and Dissemination of Methods for Prevention of Alcohol Problems in Primary Health Care: A Feasibility Study

Abstract

Secondary prevention of alcohol problems in health care has been proved efficacious in many studies, yet its implementation remains scarce, and its effectiveness in regular health care remains unknown. This article reports results from a feasibility study of dissemination of alcohol prevention methods in primary health care in Stockholm. Initial interviews with general practitioners (GPs) and district health nurses indicated that few raised the issue of alcohol with patients, made notes about alcohol in patient charts or found working with alcohol issues rewarding. The impact of a training session, where a project nurse visited all willing GPs and nurses, was limited. Although the uptake of the prevention package was high, follow-up at 3 months indicated that little use was made of the materials. Specifically, screening rates were low. In the future, secondary prevention of alcohol problems will require better adaptation to the realities of primary care.

Effectiveness of strategies to implement brief alcohol intervention in primary healthcare

“…The ''discussion'' section of the studies provided further information regarding the study findings and the conclusions of the authors. [34,37], two in Sweden [32,35], and one each in Finland [36], Denmark [33], and the USA [39].…”

“…Six studies [29,31,32,35,36,39] were conducted at the practice level. Two studies [32,36] included all PHC providers.…”

“…A non-randomized pre-test Á/post-test design was used in three studies [32,36,39] and a post-test-only design was applied in two studies [29,35]. One study [31] can be characterized as quasi-experimental, in that it compared different implementation strategies but allowed the participants to choose their preferred strategy.…”

“…The primary data sources were questionnaire self-reports and selfmonitoring reports of BI activity by the PHC personnel. One study [36] used patients' self-reports of having been asked and advised about alcohol consumption, while another study [35] used interviews with GPs and nurses to assess the value of the implementation project and activity regarding use of the materials. Table II includes information on the specific implementation strategies.…”

“…In Digiusto's study [29] nearly all GPs indicated that they were already delivering some form of relevant alcohol and drug problem intervention. The Andreasson study [35] concluded that the materials were not used frequently by the GPs, and nurses used the package even less.…”