title: GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme.
abstract: BACKGROUND
  General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme.
  
  
  METHODS
  In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme.
  
  
  RESULTS
  Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment.
  
  
  CONCLUSIONS
  A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00298220.
authors.affiliation: Radboud university medical center, Scientific Institute for Quality of Healthcare (IQ healthcare), P,O, Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands. myrna.keurhorst@radboudumc.nl.
authors.forename: Myrna
authors.initials: M
authors.lastname: Keurhorst
authors.forename: Ivonne
authors.initials: I
authors.lastname: van Beurden
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.forename: Maud
authors.initials: M
authors.lastname: Heinen
authors.forename: Reinier
authors.initials: R
authors.lastname: Akkermans
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control / Q000628:therapy*; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D037001:Directive Counseling; D005260:Female; D058005:General Practitioners / Q000193:education / Q000523:psychology / Q000592:standards; D006284:Health Plan Implementation / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D062405:Motivational Interviewing; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D024382:Professional Role; D015397:Program Evaluation; D012944:Social Support; D016896:Treatment Outcome
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