title: Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts.
abstract: Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. Latifa.abidi@maastrichtuniversity.nl.
authors.forename: L
authors.initials: L
authors.lastname: Abidi
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Oenema
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Nilsen
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.|Institute of Health and Society, Newcastle University, Newcastle, UK.
authors.forename: P
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.|IVO Addiction Research Institute, Rotterdam, The Netherlands.|Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van de Mheen
mesh_terms: D000437:Alcoholism / Q000175:diagnosis* / Q000517:prevention & control*; D000438:Alcohols / Q000302:isolation & purification*; D003695:Delivery of Health Care / Q000379:methods*; D003697:Delphi Technique; D004059:Diffusion of Innovation; D058006:General Practice; D006801:Humans; D009426:Netherlands; D011795:Surveys and Questionnaires
chemical_list: D000438:Alcohols
keywords: Alcohol; Brief intervention; General practice; Implementation; Screening