Implementing training and support, financial reimbursement, and referral to an internet-based brief 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

Abstract

BackgroundThe European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.Methods/designIn a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.DiscussionEffective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.Trial registrationClinicalTrials.gov. Trial identifier: NCT01501552

El alcoholismo y su abordaje desde una perspectiva ciudadana

“…In less than 10 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) the percentage of Spanish patients remembering that their GP had asked them about their alcohol consumption has risen from 48.9% to 57.8% (Segura Garcia et al, 2006). This may reflect the multiple efforts made to improve early identification of risky alcohol consumption, especially in the primary healthcare system (Colom, Scafato, Segura, Gandin, & Struzzo, 2014;Keurhorst et al, 2013;López-Pelayo et al, 2014).…”

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial

“…The ODHIN trial had a cluster randomized 2 × 2 × 2 factorial design 15 (with no trial deviations) allowing us to study the impact of the 3 implementation strategies on primary health care units' screening and provision of advice for heavy drinking, operationalized by AUDIT-C.…”

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

“…[21][22][23][24]40 Although not without limitation, 41,42 clinical decision support systems have been used to implement evidence-based practices across multiple conditions, [43][44][45][46][47][48][49] and many of these systems are being developed to be shareable across multiple healthcare systems, 50 especially in the U.S. in response to healthcare reform. Findings from the present and prior studies in VA suggest that while VA's alcohol screening clinical reminder has effectively prompted clinical staff to conduct screening and facilitated documentation that screening occurred, 9 it has not facilitated screening in a validated, standardized, reproducible way.…”