How Best to Implement Alcohol Screening and Brief Advice in Primary Care?

Screening and brief advice reduce self-reported alcohol consumption in primary care patients, but the optimal methods for implementing it in practices are not known. This 5-country study cluster-randomized 120 primary care units to receive one of 6 combinations of 3 implementation strategies over 12 weeks: two 1–2 hour trainings and one telephone support call; financial reimbursement for primary care units ($1–$9 per screening and $15–$27 per advice intervention); and an electronic brief intervention (eBI), which referred patients to a country-specific electronic version of the WHO e-SBI program. All received the control intervention (a summary card of the national recommendations for screening and advice).

• At baseline, primary care units screened only 6% of adults and gave advice to 74% of those who screened positive.
• Compared with control only, an increase in screening was seen among providers who received training and support, financial reimbursement, and their combination. Availability of eBI did not impact screening rates.
• No effects were observed in the proportion of patients who screened positive and who were given advice.

Comments:

Training with support and financial reimbursement both increased screening rates, but did not demonstrate additive effects, so policymakers seeking to increase screening rates can choose among these strategies. The authors cite a ceiling effect of the 74% baseline rate as explaining the null effect for brief advice, although one could argue that 100% of patients who screen positive should receive brief advice. The fidelity and effectiveness of the screening and brief advice was not assessed, so it remains uncertain whether these implementation strategies would lead to reduced heavy drinking among patients.

Peter D. Friedmann, MD, MPH

Reference:

Anderson P, Bendtsen P, Spak F, et al. Improving the delivery of brief intervention for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial. Addiction. 2016;111:1935–1945.