Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial.
This trial evaluated the clinical impact and cost-effectiveness of strategies promoting screening and brief alcohol intervention (SBI) by nurses in primary care. Randomisation was at the level of the practice and the interventions were: written guidelines (controls, n=76); outreach training (n=68); and training plus telephone-based support (n=68). After 3 months, just 39% of controls implemented the SBI programme compared to 74% of nurses in trained practices and 71% in trained and supported practices. Controls also screened fewer patients and delivered fewer brief interventions to risk drinkers than other colleagues. However, there was a trade-off between the extent and the appropriateness of brief intervention delivery with controls displaying the least errors in overall patient management. Thus cost-effectiveness ratios (cost per patient appropriately treated) were similar between the three strategies. Given the potential for anxiety due to misdirected advice about alcohol-related risk, the balance of evidence favoured the use of written guidelines to promote SBI by nurses in primary care.
Kaner
Eileen
E
Centre for Health Services Research, 21 Claremont Place, University of Newcastle upon Tyne, NE2 4AA, UK. e.f.s.kaner@newcastle.ac.uk
Lock
Catherine
C
Heather
Nick
N
McNamee
Paul
P
Bond
Senga
S
D000328:Adult; D000437:Alcoholism / Q000451:nursing / Q000517:prevention & control*; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000458:organization & administration*; D004509:Education, Nursing, Continuing; D004739:England; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D008403:Mass Screening / Q000451:nursing / Q000458:organization & administration*; D008875:Middle Aged; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000193:education; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011614:Psychotherapy, Brief / Q000458:organization & administration*