title: Alcohol screening and brief intervention in primary care settings: implementation models and predictors.
abstract: OBJECTIVE
  This study compared two different implementation strategies for Cutting Back, a primary care alcohol screening and brief intervention (SBI) program for hazardous and harmful drinkers. It also identified organizational factors contributing to the success or failure of SBI implementation.
  
  
  METHODS
  Cutting Back was implemented in 10 primary care practices associated with managed care organizations (MCOs) in five states, through a system of planning, training, technical assistance and clinic feedback. Clinics were randomly assigned to one of two brief intervention systems: In the P Model, medical providers were responsible for delivering interventions, whereas in the S Model mid-level professionals (usually nurses) acted as the clinic specialists to provide that service. Data were collected to measure the performance of screening and delivery of interventions in each clinic.
  
  
  RESULTS
  The S Model screened a higher percentage of patients than did the P Model during the best month of program operation (50% vs 44%) and over all months of operation (24% vs 19%). Of those patients who screened positive, more patients in the S condition received an intervention than in the P condition (73.1% vs 57.1%), but there was a considerable range of performance among the five sites within each condition. Results at the clinic level were mixed, with some MCOs performing alcohol SBI significantly better with the S model and others doing better with the P model. The ability of clinics to conduct SBI was significantly correlated with both provider characteristics and organizational factors (e.g., prior SBI experience, MCO stability, number of clinicians trained and the quality of the MCO coordinator's work). Lack of provider time, staff turnover and competing priorities correlated negatively with SBI performance.
  
  
  CONCLUSIONS
  The extent to which a given delivery model is likely to work best within an MCO depends on complex provider and organizational characteristics.
authors.affiliation: The Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut 06030-6325, USA. babor@nso.uchc.edu
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Babor
authors.forename: John
authors.initials: J
authors.lastname: Higgins-Biddle
authors.forename: Deborah
authors.initials: D
authors.lastname: Dauser
authors.forename: Pamela
authors.initials: P
authors.lastname: Higgins
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Burleson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*