Abstract
BACKGROUND: Providing doctors with new research findings or clinical guidelines is rarely sufficient to promote changes in clinical practice. An implementation strategy is required to provide clinicians with the skills and encouragement needed to alter established routines. AIM: To evaluate the effectiveness and cost-effectiveness of different training and support strategies in promoting implementation of screening and brief alcohol intervention (SBI) by general practitioners (GPs). METHOD: Subjects were 128 GPs, one per practice, from the former Northern and Yorkshire Regional Health Authority, who agreed to use the 'Drink-Less' SBI programme in an earlier dissemination trial. GPs were stratified by previous marketing conditions and randomly allocated to three intensities of training and support: controls (n = 43) received the programme with written guidelines only, trained GPs (n = 43) received the programme plus practice-based training in programme usage, trained and supported GPs (n = 42) received the programme plus practice-based training and a support telephone call every two weeks. GPs were requested to use the programme for three months. Outcome measures included proportions of GPs implementing the programme and numbers of patients screened and intervened with. RESULTS: Seventy-three (57%) GPs implemented the programme and screened 11,007 patients for risk drinking. Trained and supported GPs were significantly more likely to implement the programme (71%) than controls (44%) or trained GPs (56%); they also screened, and intervened with, significantly more patients. Costs per patient screened were: trained and supported GPs, 1.05 Pounds; trained GPs, 1.08 Pounds; and controls, 1.47 Pounds. Costs per patient intervened with were: trained and supported GPs, 5.43 Pounds; trained GPs, 6.02 Pounds; and controls, 8.19 Pounds. CONCLUSION: Practice-based training plus support telephone calls was the most effective and cost-effective strategy to encourage implementation of SBI by GPs.
Full Text
The Full Text of this article is available as a PDF (50.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adams P. J., Powell A., McCormick R., Paton-Simpson G. Incentives for general practitioners to provide brief interventions for alcohol problems. N Z Med J. 1997 Aug 8;110(1049):291–294. [PubMed] [Google Scholar]
- Brotons C., Iglesias M., Martin-Zurro A., Martin-Rabadan M., Gene J. Evaluation of preventive and health promotion activities in 166 primary care practices in Spain. The Coordinating Group For Prevention and Health Promotion in Primary Care in Spain. Fam Pract. 1996 Apr;13(2):144–151. doi: 10.1093/fampra/13.2.144. [DOI] [PubMed] [Google Scholar]
- Buchsbaum D. G., Buchanan R. G., Lawton M. J., Elswick R. K., Jr, Schnoll S. H. A program of screening and prompting improves short-term physician counseling of dependent and nondependent harmful drinkers. Arch Intern Med. 1993 Jul 12;153(13):1573–1577. [PubMed] [Google Scholar]
- Durand M. A. General practice involvement in the management of alcohol misuse: dynamics and resistances. Drug Alcohol Depend. 1994 Jun;35(3):181–189. doi: 10.1016/0376-8716(94)90072-8. [DOI] [PubMed] [Google Scholar]
- Fleming M. F., Barry K. L., Manwell L. B., Johnson K., London R. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA. 1997 Apr 2;277(13):1039–1045. [PubMed] [Google Scholar]
- Gomel M. K., Wutzke S. E., Hardcastle D. M., Lapsley H., Reznik R. B. Cost-effectiveness of strategies to market and train primary health care physicians in brief intervention techniques for hazardous alcohol use. Soc Sci Med. 1998 Jul;47(2):203–211. doi: 10.1016/s0277-9536(98)00063-x. [DOI] [PubMed] [Google Scholar]
- Haines A., Donald A. Making better use of research findings. BMJ. 1998 Jul 4;317(7150):72–75. doi: 10.1136/bmj.317.7150.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Israel Y., Hollander O., Sanchez-Craig M., Booker S., Miller V., Gingrich R., Rankin J. G. Screening for problem drinking and counseling by the primary care physician-nurse team. Alcohol Clin Exp Res. 1996 Nov;20(8):1443–1450. doi: 10.1111/j.1530-0277.1996.tb01147.x. [DOI] [PubMed] [Google Scholar]
- Lock C. A., Kaner E. F., Heather N., McAvoy B. R., Gilvarry E. A randomized trial of three marketing strategies to disseminate a screening and brief alcohol intervention programme to general practitioners. Br J Gen Pract. 1999 Sep;49(446):695–698. [PMC free article] [PubMed] [Google Scholar]
- Monheit B. Controlled drinking program in general practice. Aust Fam Physician. 1995 Jun;24(6):1031-4, 1036. [PubMed] [Google Scholar]
- Richmond R. L., Anderson P. Research in general practice for smokers and excessive drinkers in Australia and the UK. III. Dissemination of interventions. Addiction. 1994 Jan;89(1):49–62. doi: 10.1111/j.1360-0443.1994.tb00849.x. [DOI] [PubMed] [Google Scholar]
- Richmond R., Heather N., Wodak A., Kehoe L., Webster I. Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction. 1995 Jan;90(1):119–132. doi: 10.1046/j.1360-0443.1995.90111915.x. [DOI] [PubMed] [Google Scholar]
- Saunders J. B., Aasland O. G., Babor T. F., de la Fuente J. R., Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x. [DOI] [PubMed] [Google Scholar]