title: Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis.
abstract: OBJECTIVE
  Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC.
  
  
  METHODS
  Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models.
  
  
  RESULTS
  The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05).
  
  
  CONCLUSIONS
  To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.|Saxion University of Applied Sciences, Centre for Nursing Research, Deventer/Enschede, Sao Paulo, the Netherlands.
authors.forename: Myrna
authors.initials: M
authors.lastname: Keurhorst
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
authors.forename: Irene
authors.initials: I
authors.lastname: van de Glind
authors.affiliation: Independent consultant in public health, Brazil.
authors.forename: Michaela
authors.initials: M
authors.lastname: Bitarello do Amaral-Sabadini
authors.affiliation: Newcastle University, Institute of Health and Society, Newcastle, UK.|Maastricht University, School Caphri, Department of Family Medicine, Maastricht, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Newcastle University, Institute of Health and Society, Newcastle, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Teesside University, Health and Social Care Institute, Middlesbrough, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
authors.forename: Maud
authors.initials: M
authors.lastname: Heinen
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.|HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands.
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
mesh_terms: D000428:Alcohol Drinking / Q000191:economics / Q000517:prevention & control*; D018849:Controlled Clinical Trials as Topic; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D042241:Early Diagnosis; D006801:Humans; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Brief intervention; implementation; meta-analysis; prevention of heavy alcohol consumption; primary health care; screening; systematic review