title: Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme.
abstract: OBJECTIVE
  To assess the effect of a tailored multi-faceted improvement programme on general practitioners' (GPs') behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organization and patient. Educational training sessions and visits by a facilitator were tailored to the GPs' needs and attitudes.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  General practices in the Netherlands.
  
  
  METHODS
  Seventy-seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed.
  
  
  METHODS
  The primary outcome was the number of eligible patients who received screening and advice.
  
  
  RESULTS
  Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice-giving) at 12-month follow-up (not significant).
  
  
  CONCLUSIONS
  A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.
authors.affiliation: IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. ivonnevb@hotmail.com
authors.forename: Ivonne
authors.initials: I
authors.lastname: van Beurden
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
mesh_terms: D000428:Alcohol Drinking / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003376:Counseling; D042241:Early Diagnosis; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care