Abstract
BackgroundPrimary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice.Methods/designA quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs’ views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection.The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP’s, their practice organisation and their EIBI performance will be explored.DiscussionThe PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining T&S at GP level with community actions. At the same time, it implements and evaluates practice T&S based on the theoretical domains framework.Trial registrationThis trial was approved by the Ethics Committee for Research of UZ/KU Leuven (reference number s63342 and G-2020-2177-R2(MAR)) and is registered on clinicaltrials.gov (NCT04398576) in May 2020.
Highlights
DiscussionThe PINO-project addresses the gap between what is theoretically possible and the current practice
Primary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking
The PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining training and support (T&S) at General Practitioner (GP) level with community actions. It implements and evaluates practice T&S based on the theoretical domains framework
Summary
The strength of this study is the combination of training and interactive support, tailored to a theory-based implementation strategy (TDF and BCW) and measured during the implementation process. PINO addresses both in- and external barriers and facilitators. It is possible that GPs remember to register, but do not fill in the e-form correctly These problems should occur less in the cities where GPs receive T&S. These concerns have been taken into account while designing this study by integrating both e-forms as well as clinical auditing of the EHR. The e-form provides GPs the opportunity to discuss and systematically record how much alcohol their patients use. Another matter to consider is the possibility that data collection is incomplete due to technical errors, which will be take into account during the analysis.
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