Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial

Abstract

Aims To test if training and support of primary health care providers (PHCP), financial reimbursement to PHCP for screening and brief advice, and option for PHCP to refer screen positive patients to an internet-based method of giving advice (eBI) increases PHCP's delivery of screening and advice to heavy drinkers, compared to a control group of PHCPs.Design Cluster randomized factorial trial with 12-week implementation measurement period.Setting Primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden.Participants 120 PHCU, 24 in each of Catalonia, England, 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.Outcome measures Primary outcome measures is proportion of eligible patients screened during a 12-week implementation period. Secondary outcome measures are 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.Results During a 4-week baseline measurement period, 5.9 (95% CI 3.4 to 8.4)per 100 adult patients consulting per PHCU were screened for their alcohol consumption. Based on the factorial design, PHCU that received TS had a 1.48 (95% CI 1.13 to 1.95)relatively higher proportion of patients screened during the 12-week implementation period than PHCU that did not receive TS; PHCU that received FR had a 2.00 (95% CI 1.56 to 2.56) relatively higher proportion than no FR. The option of referral to eBI did not have a higher proportion. A combination of TS plus FR had a 2.34 (95% CI 1.77 to 3.10) relatively higher proportion of patients screened than no TS plus FR. A combination of TS plus FR plus eBI had a 1.68 (95% CI 1.11 to 2.53) relatively higher proportion of patients screened than no TS plus FR plus eBI.Conclusions Training and support of PHCP, and financial reimbursement to PHCP for screening and brief advice increase the proportion of adult patients screened for their alcohol consumption, at least in the short term. Trial registration ClinicalTrials.gov. Trial identifier: NCT015015523

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

“…13 During that implementation period, the ratio of the log of the proportion given the intervention was 1.61 (95% CI, 1.24-2.10) in units that received training and support vs units that did not; for financial reimbursement, the ratio was 2.00 (95% CI, 1.49-2.47), and for training and support plus financial reimbursement, the ratio was 2.44 (95% CI, 1.85-3.22). In the present analysis, we have demonstrated a lasting effect of training and support at 9 months of follow-up, with the ratio of the log of the proportion given an intervention at that time of 1.39 (95% CI, 1.03-1.88) for units that received training and support vs units that did not.…”

“…Previously, we found some evidence that the volunteering units were more motivated to work with drinkers than similar units from the same country in general. 13 A second weakness of our study is that the tally sheet used to measure AUDIT-C included all of the options for giving advice. In itself, this sheet is an organizational intervention to support clinician behavior, although it was provided equally across all 8 groups.…”

“…The opportunity to refer patients to an electronically delivered brief advice program (hereafter simply called e-advice) did not change the proportion, however. 13 During the implementation period, practitioners were asked to screen all consulting adult patients-regardless of the reason for their visit-for heavy drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool 14 and to give brief advice to screenpositive patients. For the primary care physicians, training and support, and financial reimbursement worked mainly by increasing the proportion of patients screened, rather than by increasing the proportion of screen-positive patients advised, which was already high (74%) at baseline.…”

Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial

“…This can be changed with professional and organizational-based interventions [4,5]. During the 1970s, the Maudsley Alcohol Pilot Project was set up in the United Kingdom to make practical recommendations for an improved local response to dealing with drinking problems [6].…”

Impact of Financial Incentives on Alcohol Consumption Recording in Primary Health Care Among Adults with Schizophrenia and Other Psychoses: A Cross-Sectional and Retrospective Cohort Study

“…However, despite their widespread use, there is mixed evidence for their impact on quality of care, with few methodologically robust evaluations, such as interrupted time series or controlled before-and-after studies with contemporaneous control groups (Houle et al, 2012;Scott et al, 2011). The largest and most recent randomised controlled trial to explore the impact of implementation strategies for alcohol screening and brief interventions in 120 primary care practices in five European countries (ODHIN) found financial incentives combined with training and support to be most effective at improving rates of screening and brief intervention, compared with 1) treatment as usual, 2) training and support, 3) financial reimbursement alone, 4) electronic screening and brief intervention, and combinations of these interventions (Anderson et al, 2016;Keurhorst et al, 2013). Moreover, financial incentives were found to be the most cost-effective of these implementation strategies, with incentive and delivery costs amounting to £110 million over 10 years, but leading to £250 million of savings to the NHS and saving 33,000 Quality Adjusted Life Years (QALYs) (Angus et al, 2014).…”