Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme

Abstract

A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.

A Randomized Controlled Trial of a Tailored Primary Care Program to Reverse Excessive Alcohol Consumption

“…15 Therefore, we developed a multifaceted intervention on GPs' behavior toward prevention of hazardous and harmful alcohol consumption, and we conducted a randomized, controlled study to assess its 1-year effects on GPs' screening and advice-giving behavior and its 2-year effects on the level of alcohol consumption of patients. 19 As reported in a previous article, 19 our program did not result in improvement in rates of screening and giving of advice. In this article, we focus on the effect of our program on the level of alcohol consumption of patients.…”

“…In this article, we focus on the effect of our program on the level of alcohol consumption of patients. When considering the results of the previous article, 19 a significant effect on patient outcome cannot reasonably be expected from our program. We therefore hypothesized that between GPs involved in the intervention program compared with those in the control group there will be no difference in the proportion of patients with hazardous and harmful alcohol consumption who reduced their levels of alcohol consumption to low-risk levels.…”

Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta‐analysis

“…In addition, six studies reported a combination of professional oriented and organisational oriented implementation strategies, in which in all educational meetings were applied, combined with either changes in medical record systems, formal integration of services or skill mix changes (49-54). Eight studies reported various combinations of professional oriented, organisational oriented, patient oriented and financial oriented strategies (11,23,24,(55)(56)(57)(58)(59).…”

“…However, SBI is underused with less than 10% of those who might benefit from SBI, receiving a brief intervention (10). Largescale studies that have attempted to increase the uptake of brief interventions have shown that implementing brief interventions in PHC remains difficult (11)(12)(13).…”

“…The impact of SBI on patients' alcohol consumption has been studied in many trials (e.g. (11,24,25)), but earlier systematic reviews did not provide practical guidance in how to increase SBI uptake in practice (4,6,7,26). More insight is needed on how the uptake of SBI in PHC practice can be increased to contribute to health benefits.…”