Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches

Coulton, Simon; Dale, Veronica; Deluca, Paolo; Gilvarry, Éilish; Godfrey, Christine; Kaner, Eileen; McGovern, Ruth; Newbury‐Birch, Dorothy; Patton, Robert; Parrott, Steve; Perryman, Katherine; Phillips, Tom; Shepherd, Jonathan Paul; Drummond, Colin

doi:10.1093/alcalc/agx017

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…Although screening based only on consumption may encourage the disclosure by parents, the findings of our DCE suggests that such an approach may not encourage social care practitioner’s to administer the tool as it does not seek to identify those parents whose drinking impacts upon the child. A move away from universal screening approaches recommended within health settings ( Coulton et al., 2017 ) towards targeted screening based upon observable problems within the family linked to alcohol may be necessary within a social care setting.…”

Section: Discussionmentioning

confidence: 99%

Preferences for Delivering Brief Alcohol Intervention to Risky Drinking Parents in Children’s Social Care: A Discrete Choice Experiment

McGovern

Homer

Kaner

et al. 2022

Alcohol and Alcoholism

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Aims Many parents in contact with children’s social care services misuse alcohol however do not meet the threshold for specialist alcohol treatment, and typically do not receive appropriate support for their needs. Brief alcohol interventions have been found to be effective in healthcare settings, however, it is unknown whether the brief intervention structure delivered within health settings would transfer well into children’s social care. This paper aims to examine the characteristics of brief intervention for alcohol misusing parents which social care practitioners consider to be important and acceptable to implement in this sector. Methods We assessed preferences for, and acceptability of, brief alcohol intervention with parents in contact with children’s social care using a discrete choice experiment. We recruited 205 children’s social care practitioners from London and the North East of England. Data were analysed using mixed logit which accounted for repeated responses. Findings Six attributes showed statistically significant coefficients, suggesting that a brief intervention with these attributes would encourage implementation. These were: level of alcohol-related risk targeted; intervention recipient; timing of intervention; duration of sessions; number of sessions and intervention structure. The attribute of most importance identified based on the attribute with the largest coefficient in the conditional logit model was risk level. Conclusions Brief alcohol interventions delivered to parents in social care should focus on the impact upon children and the wider family, they should be a flexible part of on-going casework and should be more intensive and less structured.

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Section: Discussionmentioning

confidence: 99%

Preferences for Delivering Brief Alcohol Intervention to Risky Drinking Parents in Children’s Social Care: A Discrete Choice Experiment

McGovern

Homer

Kaner

et al. 2022

Alcohol and Alcoholism

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“…However, to date, there is insufficient evidence for an appropriate package that deals with comorbidity to scale-up 63 . Further, it has been shown that targeted screening misses out on the vast majority of patients that would be captured by universal screening 64 . Given the strong associations between harmful alcohol use and depression 65 , 66 , our protocol includes screening for depression and appropriate PHC-based management 67 – 69 or referral for those patients identified as screen positive by AUDIT-C.…”

Section: Introductionmentioning

confidence: 99%

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

et al. 2017

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Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017.

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“…Moreover, GPs are often resistant toward universal, population-based approaches to SBI, presumably because of their laborious and time-consuming nature (16). Targeted or symptom-based approaches are more acceptable to GPs, and evidence suggests that targeted screening may be more efficient as it yields a higher prevalence of at-risk alcohol consumers than universal screening (17). Several strategies based on clinical relevance have been reported, e.g., semi-systematic method, pragmatic case findings, and relevance criteria, the latter focused on smoking but used a similar logic (13,18,19).…”

Section: Introductionmentioning

confidence: 99%

“…To date however, most studies on SBI have focused on universal, widespread screening; far fewer studies have explored pragmatic (targeted or relevance-based) strategies to identifying hazardous or harmful drinkers in health care settings (17,18,22). One study compared universal screening of all patients vs. targeted screening focused on clinical relevance.…”

Section: Introductionmentioning

confidence: 99%

Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention

Potthoff¹,

O’Donnell²,

Karlsen³

et al. 2022

Front.Health Serv.

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IntroductionAlcohol consumption is a leading global risk factor for ill-health and premature death. Alcohol screening and brief interventions (SBI) delivered in primary care is effective at reducing alcohol consumption, but routine implementation remains problematic. Screening all patients for excessive drinking (universal screening) is resource-intensive and may be at odds with general practitioners' (GPs') perceived professional role. This study aimed to develop a tailored, theory-based training intervention to strengthen GPs' ability to address alcohol and to manage alcohol-related health problems through a pragmatic approach based on clinical relevance.MethodsA qualitative study design involving focus group interviews and a structured questionnaire for free text replies with GPs in Norway. Behavioral analysis assessed factors influencing delivery of SBI according to the ‘capability, opportunity, motivation and behavior' (COM-B) model to inform intervention development using the Behavior Change Wheel. Qualitative data were analyzed using framework analysis and an iterative approach was adopted to develop the training.ResultsA purposive sample of GPs attended the focus groups (n = 25) and completed the questionnaire (n = 55). Four areas required additional support including: understanding the link between alcohol use and health problems; opening up the conversation on alcohol use; addressing alcohol and dealing with obstacles; and following-up and maintaining change. Findings informed the development of a four-session interactive training intervention and a digital intervention for providing support for patients between consultations to address the identified needs.ConclusionThis work highlights the value of pragmatic, relevance-based clinical strategies, as opposed to universal screening approaches to addressing alcohol in primary care. A pragmatic approach is more in line with GPs existing sclinical skill set and holds the potential to improve widespread uptake and implementation of SBI in routine primary care.

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Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches

Abstract: Current Controlled Trials ISRCTN06145674.

Cited by 11 publications

References 29 publications

Preferences for Delivering Brief Alcohol Intervention to Risky Drinking Parents in Children’s Social Care: A Discrete Choice Experiment

Preferences for Delivering Brief Alcohol Intervention to Risky Drinking Parents in Children’s Social Care: A Discrete Choice Experiment

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention

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