title: Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial.
abstract: To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.
  
  
  
  Cluster randomized factorial trial with 12-week implementation and measurement period.
  
  
  
  Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.
  
  
  
  A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.
  
  
  
  PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.
  
  
  
  The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period.
  
  
  
  During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53).
  
  
  
  Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK. peter.anderson@newcastle.ac.uk.|Department of Family Medicine, Maastricht University, Maastricht, the Netherlands. peter.anderson@newcastle.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.affiliation: Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden.
authors.forename: Preben
authors.initials: P
authors.lastname: Bendtsen
authors.affiliation: Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Spak
authors.affiliation: Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Jillian
authors.identifier: 0000-0002-2516-4146
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.|National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Segura
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.
authors.forename: Myrna N
authors.initials: MN
authors.lastname: Keurhorst
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Palacio-Vieira
authors.affiliation: Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wojnar
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Parkinson
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Colom
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Kłoda
authors.affiliation: National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Deluca
authors.affiliation: Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Baena
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wallace
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.
authors.forename: Maud
authors.initials: M
authors.lastname: Heinen
authors.affiliation: National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Wolstenholme
authors.affiliation: Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: van Steenkiste
authors.affiliation: Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Mierzecki
authors.affiliation: State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Okulicz-Kozaryn
authors.affiliation: Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
authors.forename: Gaby
authors.initials: G
authors.lastname: Ronda
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.|HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands.
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
authors.affiliation: Centre for Health Service Studies, University of Kent, Canterbury, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Coulton
authors.affiliation: Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Toni
authors.initials: T
authors.lastname: Gual
mesh_terms: D000428:Alcohol Drinking / Q000517:prevention & control*; D000437:Alcoholism / Q000175:diagnosis; D016000:Cluster Analysis; D003376:Counseling; D003695:Delivery of Health Care / Q000592:standards; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care; D011614:Psychotherapy, Brief / Q000379:methods*
keywords: Brief interventions; ODHIN; financial reimbursement; heavy drinking; implementation; primary health care; training and support