Abstract
PurposeWe aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured.MethodsWe undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage).ResultsThe combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5).ConclusionsTraining of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions.Trial RegistrationClinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599
Highlights
Alcohol use is a leading risk factor for ill-health and premature death, increasing a wide range of cancers, and cardiovascular and gastrointestinal diseases[1,2,3,4]
Anderson et al.: Primary Health Care and Alcohol level health service access to measurement of alcohol consumption, and delivering brief advice and treatment as required, is one of five high-impact strategies to reduce the harm done by alcohol[5]
While no published data is available of the extent of primary health care (PHC)-based measurement and brief advice activity in reducing heavy drinking in the three study countries of the SCALA trial (Colombia, Mexico, and Peru), the country investigators report that such work is not normally undertaken
Summary
Alcohol use is a leading risk factor for ill-health and premature death, increasing a wide range of cancers, and cardiovascular and gastrointestinal diseases[1,2,3,4]. JGIM level health service access to measurement of alcohol consumption, and delivering brief advice and treatment as required, is one of five high-impact strategies to reduce the harm done by alcohol[5]. A number of meta-analyses and systematic reviews have demonstrated the impact[6,7,8] and cost-effectiveness[9, 10] of primary health care (PHC)–based measurement and brief advice programmes in reducing heavy drinking. Having more time, having less intense programmes to deliver, and having more active patients asking for alcohol advice have been expressed as facilitators for implementing measurement and brief advice[19, 20]
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