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Research Summary

Alcohol Screening and Brief Intervention in General Practice: Can You Lead a Mule to Water?

Although screening and brief intervention (SBI) can effectively address risky drinking in primary care settings, it has proven difficult to implement in routine clinical practice. This study randomized 77 general practices with 119 general practitioners (GPs) in the Netherlands to a comprehensive multifaceted program of professional, organizational, and patient-related activities designed to implement either SBI or usual care (mailed information on problem drinking). The intervention included distribution of guidelines from the Dutch College of GPs; GP training; a reminder card; practice-level feedback on the number of risky drinkers in the practice; facilitation of cooperation with local addiction services; outreach visits to the practice by a trained facilitator; and patient information letters and personalized feedback about their drinking with advice for risky drinkers to consult their physician.

  • Practices were hard to recruit: 2758 general practices were invited, but only 82 agreed (5 withdrew after randomization) because of the requirement that every GP agree to participate.
  • Despite such agreement, only half of the 40 intervention practices met the minimum requirement that every GP attend at least 1 training session and 1 facilitator visit.
  • At baseline, the proportion of patients screened (18% in the control group, 15% in the intervention group) and given advice (3% for both groups) was very low.
  • Medical record review found that the proportion of at-risk patients screened or given advice about alcohol increased from baseline for both groups during the study period but waned at 1-year follow-up, with no differences detected.
  • On a self-report questionnaire, screening rates declined from baseline to 1-year follow-up.

Comments:

In this study, the difficulty recruiting practices, resistance to training, and null results demonstrate the infeasibility of getting large groups of primary care physicians to implement alcohol SBI through traditional training and support. Clearly, other implementation strategies must be developed and tested, including strong incentives or bypassing the physician altogether through the use of other providers or technology. Peter D. Friedmann, MD, MPH

Reference:

van Beurden I, Anderson P, Akkermans RP, et al. Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme. Addiction. 2012;107(9):1601–1611.

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