Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial.
BACKGROUND
The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.


METHODS
In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals' role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.


CONCLUSIONS
Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.
Scientific Institute for Quality of Healthcare-IQ Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands. m.keurhorst@iq.umcn.nl
Myrna N
MN
Keurhorst
Peter
P
Anderson
Fredrik
F
Spak
Preben
P
Bendtsen
Lidia
L
Segura
Joan
J
Colom
Jillian
J
Reynolds
Colin
C
Drummond
Paolo
P
Deluca
Ben
B
van Steenkiste
Artur
A
Mierzecki
Karolina
K
Kłoda
Paul
P
Wallace
Dorothy
D
Newbury-Birch
Eileen
E
Kaner
Toni
T
Gual
Miranda G H
MG
Laurant
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000517:prevention & control*; D016000:Cluster Analysis; D003376:Counseling / Q000379:methods*; D042241:Early Diagnosis; D058006:General Practice / Q000191:economics / Q000193:education / Q000592:standards; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D020407:Internet; D008875:Middle Aged; D009042:Motivation; D009722:Nurse Practitioners / Q000193:education; D017063:Outcome Assessment, Health Care; D010823:Physician Assistants / Q000193:education; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms; D018401:Sample Size; D055815:Young Adult