Effectiveness of strategies to implement brief alcohol intervention in primary healthcare

Figures & data

Table I.  Key features of the studies.

Study publication; year	Setting; n = number of practices	Participants	Recruitment of participants	Study design; groups compared; use of control group	Outcome measures; measurement points; data sources
Digiusto [29]; 1998	Western Sydney, Australia; n = not reported	34 GPs	Sample pool: 572 GPs in the study area. Survey questionnaire recruitment; 32% of GPs (n = 183 GPs) agreed to participate in some form of alcohol and other drug problems training; 19% of these (n = 34 GPs) wanted training in intervention for excessive alcohol consumption and were invited to training workshops	Post-test only; no comparisons; no control group	MUR, BIR; 31 weeks (average) after training; GP questionnaire
Gomel [30]; 1998	45-km radius of urban hospital in Sydney, Australia; n = 127	127 GPs	Sample pool: 1759 PHC practitioners. From this pool, 628 family physicians were randomly selected and assigned to 3 marketing strategies to promote the uptake of BI materials; 127 physicians who requested the materials agreed to participate in the subsequent training and support project	RCT post-test only; Comparison of 3 strategies; control group	SR, BIR; After completion of study period; GP self-monitoring report
Richmond [31]; 1998	South Eastern Sydney, Australia; n = not reported	96 GPs	Sample pool: GPs in the study area; 64% of GPs (n = 96) agreed to participate	Quasi-experimental post-test only; Comparison of 3 strategies; no control group	MUR, SR, BIR; 6 months after training; GP questionnaire and self-monitoring reports
Bendtsen [32]; 1999	Östergötland, Sweden; n = 4	19 GPs and 30 nurses	Personnel (“the great majority”) in 4 selected PHC centres from the study area participated	Pre-test–post-test; Comparison of 2 personnel categories; no control group	SR, BIR; prior to and 4 months after study start; GP/nurse questionnaire
Hansen [33]; 1999	26-km radius of Copenhagen hospital, Denmark; n = 81	81 GPs	Sample pool: 386 GPs in all 285 practices of the study area. A sample of GPs was selected that included 1 GP per practice for half of the practices. All GPs in single-handed practices were chosen Among the group practices, only 1 GP per practice was chosen; 57% of GPs (n = 81) of 143 approached agreed to participate	RCT post-test only; Comparison of 3 strategies; no control group	MUR; 1 month after receipt of the materials; GP questionnaire
Kaner [34]; 1999	Yorkshire, England; n = 128	128 GPs	Participating GPs had taken up and agreed to use the BI materials in an earlier study	RCT post-test only; comparison of 2 strategies with control group strategy; control group	MUR, SR, BIR; 3 months after study start; GP self-monitoring report
Andreasson [35]; 2000	Stockholm, Sweden; n = not reported	37 GPs and 44 nurses	Sample pool: 53 GPs and 55 nurses in the study area. Telephone recruitment by a research assistant was used; 70% of GPs (n = 37) and 82% of nurses (n = 44) agreed to participate	Post-test only; no comparisons; no control group	SR, BIR; 3 months after study start; GP interview
Aalto [36]; 2003	Tampere, Finland; n = 2	14 GPs and 10 nurses	All personnel in 2 selected PHC centres	Pre-test–post-test; no comparisons; no control group	SR, BIR; prior to and 3 years after study start; patient questionnaire
Kaner [37]; 2003	Northern England; n = 212	212 nurses	Sample pool: 312 general practices (a practice was eligible for study inclusion if it contained at least 1 nurse who would not be away from practice for more than 2 weeks during the study period). Telephone recruitment by a research assistant was used, employing a scripted conversation to secure nurse agreement to participate; 79% of the nurses (n = 212) agreed to participate	RCT post-test only; Comparison of 2 strategies with control group strategy; control group	MUR, SR, BIR; after 3 months; nurse questionnaire
Anderson [38]; 2004	Australia, Belgium, Catalonia, and England; n = 340	340 GPs	Sample pool: 2924 GPs in databases of practitioners maintained by national and regional health authorities or by academies and associations of GPs who had requested and agreed to use the BI package in an earlier study. Of 632 GPs who agreed to use the package, 340 GPs participated in this study	RCT post-test only; comparison of 1 strategy with control group strategy; control group	SR, BIR; after 3 months; GP questionnaire
Babor [39]; 2004	West, Southwest, Midwest, and Northeast regions of the USA; n = 15	44 physicians, 88 medical students, and 44 non-physicians	10 practices participated, while 5 practices served as controls	Pre-test–post-test; comparison of 1 strategy with control group strategy and comparison of 3 personnel categories; control group	SR, BIR; prior to and 3 months after practice visit; patient questionnaire

Note: Abbreviations: MUR = material utilisation rate; SR = screening rate; BIR = brief intervention rate.

Table II.  Description of the implementation strategies and key results.

Study publication; year	BI materials	Strategy 1: Mailed materials (no training)	Strategy 2: Telemarketing (short introduction and materials)	Strategy 3: Materials and training	Strategy 4: Materials, training, and subsequent support
Digiusto [29]; 1998	Not described			Workshop. Duration or content of training not given; n = 34 GPs; MUR – 14% of screening forms used, BIR – 24% of eligble patients = 7.09 eligible patients/GP/week
Gomel [30]; 1998	AUDIT questionnaire, provider advice handycard, patient booklet	Group 1: n = 34 physicians; SR – 6.34 patients/physician/week, BIR – 9% of eligible patients = 1.64 eligible patients/GP/week		Group 2: Training in the use of the package. Duration not given; n = 45 physicians; SR – 12.87 patients/physician/week, BIR – 13% of eligible patients = 1.72 eligible patients/GP/week	Group 3 = Group 2 plus reminders; n = 40 physicians; SR – 12.68 patients/physician/week, BIR – 13% of eligible patients = 1,64 eligible patients/GP/week; Group 4 = Group 2 plus alternate phone contacts and practice visits every 2 weeks; n = 42 physicians; SR – 16.27 patients/physician/week, BIR – 22% of eligible patients = 2.67 eligible patients/GP/week
Richmond [31]; 1998	Chart for patient education, booklets for patients, self-help manual, summary sheet	Group 1: n = 22 GPs; MUR – 36% users of the materials after 6 months		Group 2: Academic detailing. Duration not given; n = 39 GPs; MUR – 57% users of the materials after 6 months; Group 3: Two-hour training workshop; n = 35 GPs; MUR – 63% users of the materials after 6 months; For all groups: SR – 9.48 patients/GP/week, BIR – 38% of eligible patients = 0.41 eligible patients/GP/week
Bendtsen [32]; 1999	CAGE questionnaire, consumption questionnaire, provider manual, patient booklet				Outreach training (GPs 30 min and nurses 45 min). A project team of 3 persons then supported personnel during 4–8 weeks and supervised BI done by the PHC's own staff; n = 19 GPs and 30 nurses; SR – 83% of GPs and 25% of nurses reported screening “more often” or “much more often”, BIR – 75% of GPs and 26% of nurses reported giving BI “more often” or “much more often”
Hansen [33]; 1999	AUDIT questionnaire, provider advice handycard, patient booklet	Group 1: n = 47 GPs; MUR – 57% screened at least one patient	Group 2: A researcher phoned the practice, asking the GP if he/she was interested in receiving the BI package. A script was used, containing answers to the most likely questions; n = 50 GPs; MUR – 31% screened at least one patient	Group 3: Academic detailing. Duration not given; n = 46 GPs; MUR – 61% screened at least one patient
Kaner [34]; 1999	AUDIT questionnaire, provider advice handycard, patient booklet	Group 1: n = 43 GPs; MUR – 44% screened at least one patient, SR – 4.19 patients/GP/week, BIR – 52% of eligible patients were advised = 0.76 eligible patients/GP/week and 27% of eligible patients were given booklet = 0.39 eligible patients/GP/week		Group 2: Face-to-face training at the practice. Duration not given; n = 43 GPs; MUR – 56% screened at least one patient, SR – 7.15 patients/GP/week, BIR – 59% of eligible patients were advised = 1.28 eligible patients/GP/week and 30% of eligible patients were given booklet = 0.65 eligible patients/GP/week	Group 3: Same face-to-face training plus ongoing support and advice via fortnightly phone calls during 12 weeks; n = 42 GPs; MUR – 71% screened at least one patient, SR – 10.2 patients/GP/week, BIR – 60% of eligible patients were advised = 1.98 eligible patients/GP/week and 29% of eligible patients were given booklet = 0.96 eligible patients/GP/week; For all groups: SR – 7.17 patients/GP/week, BIR – 58% of eligible patients were advised = 1.33 eligible patients/GP/week and 29% of eligible patients were given booklet = 0.66 eligible patients/GP/week
Andreasson [35]; 2000	AUDIT questionnaire, provider manual, patient booklet			Practice visit by project nurse to provide “a brief outline of methods for secondary prevention and a demonstration of materials useful for this purpose”. Mean duration: GPs 30 min and nurses 45 min; n = 37 GPs and 44 nurses; SR – 0.095 patients/GP/week (filled in AUDIT questionnaire) and 0.024 patients/nurse/week (filled in AUDIT questionnaire), BIR – 0.164 patients/GP/week (given patient booklet) and 0.054 patients/nurse/week (given patient booklet) (number of eligible patients not stated)
Aalto [36]; 2003	AUDIT questionnaire, provider advice, patient booklet				A model of how to do BI and how to disseminate was developed together with PHC providers through action research. Education based on needs was given and a project nurse and physician were available for consultation in problematic situations. Community action and communication strategy were included to change attitudes. Study duration was 3 years; n = 14 GPs and 10 nurses; SR – baseline 19% = 1.30 patients/GP or nurse/week and follow-up 20% = 1.57 patients/GP or nurse/week, BIR – baseline 13% of eligible patients = 0.14 eligible patients/GP or nurse/week and follow-up 15% of eligible patients = 0.18 eligible patients/GP or nurse/week
Kaner [37]; 2003	AUDIT questionnaire, provider advice handycard, patient booklet	Group 1: n = 76 nurses. MUR – 39% screened at least one patient, SR – 1.66 patients/nurse/week, BIR – 60% of eligible patients = 0.24 eligible patients/nurse/week		Group 2 Training in how to use the package during an outreach visit. Mean duration: 34 min; n = 68 nurses; MUR – 74% screened at least one patient, SR – 2.37 patients/nurse/week, BIR – 61% of eligible patients = 0.41 eligible patients/nurse/week	Group 3 = Group 2 plus 2 weekly phone calls during 12 weeks; n = 68 nurses; MUR – 71% screened at least one patient, SR – 2.56 patients/nurse/week, BIR – 64% of eligible patients = 0.45 eligible patients/nurse/week
Anderson [38]; 2004	AUDIT questionnaire, provider advice handycard, patient booklet	Group 1: n = 168 GPs. SR – 21% reported “high activity” (screened at least 20% of patients), BIR – 23% reported “high activity” (at least 10% of eligible patients were advised or given booklet)			Group 2: Outreach training (duration not given) and then ongoing support/advice via alternate phone calls and visits during 12 weeks; n = 1.72 GPs; SR – 39% reported “high activity” (screened at least 20% of patients), BIR −45% reported “high activity” (at least 10% of eligible patients were advised or given booklet)
Babor [39]; 2004	AUDIT questionnaire, decision-making guide, patient brochures	Group 1: n = unknown number in 5 clinics. SR – 0.14 patients/physician/week and 0.03 patients/non-physician/week, BIR −0.12 eligible patients/physician/week and 0.03 eligible patients/non-physician/week were “managed for drinking”			Group 2: Outreach training delivered in less than 3 hours plus technical assistance available via phone or email and through occasional site visits. Study duration not given; n = 44 physicians, 88 medical students, 44 non-physicians; SR −0.56 patients/physician/week and 0.72 patients/non-physician/week, BIR −0.63 eligible patients/physician/week and 0.36 eligible patients/non-physician/week were “managed for drinking”

Notes: Abbreviations: MUR = material utilization rate; SR = screening rate; BIR = brief intervention rate n = number of PHC personnel. All percentages rounded off. Eligible patients defined differently among the studies.

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