title: Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking.
  
  
  METHODS
  Pragmatic cluster randomised controlled trial.
  
  
  METHODS
  Primary care practices in the north east and south east of England and in London.
  
  
  METHODS
  3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers.
  
  
  METHODS
  Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation.
  
  
  METHODS
  The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler.
  
  
  RESULTS
  Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings.
  
  
  CONCLUSIONS
  All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN06145674.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK. e.f.s.kaner@newcastle.ac.uk
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.forename: Martin
authors.initials: M
authors.lastname: Bland
authors.forename: Paul
authors.initials: P
authors.lastname: Cassidy
authors.forename: Simon
authors.initials: S
authors.lastname: Coulton
authors.forename: Veronica
authors.initials: V
authors.lastname: Dale
authors.forename: Paolo
authors.initials: P
authors.lastname: Deluca
authors.forename: Eilish
authors.initials: E
authors.lastname: Gilvarry
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
authors.forename: Nick
authors.initials: N
authors.lastname: Heather
authors.forename: Judy
authors.initials: J
authors.lastname: Myles
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.forename: Adenekan
authors.initials: A
authors.lastname: Oyefeso
authors.forename: Steve
authors.initials: S
authors.lastname: Parrott
authors.forename: Katherine
authors.initials: K
authors.lastname: Perryman
authors.forename: Tom
authors.initials: T
authors.lastname: Phillips
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shepherd
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
mesh_terms: D000437:Alcoholism / Q000517:prevention & control / Q000534:rehabilitation*; D016000:Cluster Analysis; D003376:Counseling / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D058006:General Practice; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D040242:Risk Reduction Behavior; D016896:Treatment Outcome