Screening and brief intervention targeting risky drinkers in Danish general practice--a pragmatic controlled trial.
OBJECTIVE
Recommendations for routine alcohol screening and brief counselling intervention in primary health care rest on results from intervention efficacy studies. By conducting a pragmatic controlled trial (PCT), we aimed at evaluating the effectiveness of the WHO recommendations for screening and brief intervention (SBI) in general practice.


METHODS
A randomized PCT (brief counselling intervention vs no intervention) involving 39 Danish general practitioners (GPs). Systematic screening of 6897 adults led to inclusion of 906 risky drinkers, and research follow-up on 537 of these after 12-14 months. Outcome measures focused on patients' acceptance of screening and intervention and their self-reported alcohol consumption.


RESULTS
Patient acceptance of screening and intervention -10.3% (N = 794) of the target population (N = 7, 691) explicitly refused screening. All intervention group subjects (N = 442) were exposed to an instant brief counselling session while only 17.9% of them (79/442) attended a follow-up consultation that was offered by their GP. Consumption Changes At one-year follow-up, average weekly consumption had increased by 0.7 drinks in both comparison groups. As secondary findings, we observed an indiscriminate absolute risk reduction (ARR = 0.08 (95% CI: -0.02; 0.18)) in male binge drinking, but adverse intervention effects for women on the secondary outcomes (binge drinking ARR = -0.30 (95% CI: -0.47; -0.09)).


CONCLUSIONS
The results of brief interventions in everyday general practice performed on the basis of systematic questionnaire screening may fall short of theoretical expectations. When applied to non-selected groups in everyday general practice SBI may have little effect and engender diverse outcome. Women may be more susceptible to defensive reactions than men.
Beich
Anders
A
Research Unit and Department for General Practice, University of Copenhagen, Centre for Health and Community, Oster Farimagsgade 5, DK-1014 Copenhagen K, Denmark. ab@gpract.ku.dk
Gannik
Dorte
D
Saelan
Henrik
H
Thorsen
Thorkil
T
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D003718:Denmark / Q000453:epidemiology; D005194:Family Practice / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010819:Physician's Role; D012307:Risk Factors