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Training, support critical to successful interventions with heavy drinkers

Training and support of primary health care units in Europe had a lasting, although small, impact on the proportion of adult patients given an alcohol intervention at 9 months, according to research published in the Annals of Family Medicine.

Identifying strategies that may help curb alcohol abuse could offer significant health benefits. Research suggests that drinking continues to be a problem in the United States. A study published in the American Journal for Public Health in 2015 found that any drinking prevalence ranged from 11% to 78.7% in 2012 across all counties in the United States, and that heavy drinking prevalence ranged from 2.4% to 22.4% in the same year across the same geographical swath.

In addition, another study released earlier this year found that more than one in 10 U.S. adults consumed more than twice the number of drinks that is considered binge drinking on at least one occasion.

“Many national and international guidelines recommend routine screening for heavy drinking in primary care and the offering of advice to screen-positive patients,” Peter Anderson, PhD, of the Institute of Health and Society, Newcastle University, England, and colleagues wrote. “In many settings, however, there is a large gap between need and provision of advice.”

Anderson and colleagues conducted a cluster-randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Sweden, Poland, the Netherlands, England and the Catalonia region of Spain. The units were randomly assigned into one of the following groups: care as usual; training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all three conditions combined. The primary outcome was the proportion of consulting adult patients receiving intervention — screening and, if screen-positive, advice — at 9 months.

Anderson and colleagues found that the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. They also wrote that their findings build on a previous study that suggested up to 4 hours of training and support for primary care clinicians and monetary reimbursement delivered during a 12-week implementation period alone and in tandem increased the proportion of heavy drinkers given an intervention (screening and advice given to screen-positive patients) to reduce their drinking.

“On the basis of our ... findings reported previously and here, we recommend that all jurisdictions consider providing training and support to primary health care clinicians in delivering screening and brief advice, so as to increase the provision of brief interventions delivered to patients in primary care who drink heavily,” Anderson and colleagues wrote. “Given the drop-off in impact over time, repetition of training and support over a longer period is desirable. Our findings confirm some of the difficulties of the sustainability of financial reimbursement, as we found that its impact ceased when payments ended.” – by Janel Miller

References:

CDC. Fact Sheets – Alcohol Use and Your Health. Accessed July 10, 2017.

Dwyer-Lindgren L, et al. Am J Public Health. 2015;doi:10.2105/AJPH.2014.302313.

Disclosures: Anderson reports no relevant financial disclosures. Please see the study for a full list of the other authors’ relevant financial disclosures.