Risky Alcohol Consumption Research Articles

Comparing counselling models for the hazardous use of alcohol at the Swedish National Alcohol Helpline: study protocol for a randomised controlled trial

BackgroundHazardous and harmful consumption of alcohol is a leading cause of preventable disease and premature deaths. Modifying the amount and pattern of risky alcohol consumption conveys substantial benefits to individuals and to society at large. Telephone helplines provide a feasible alternative to face-to-face counselling in order to increase the reach of brief interventions aiming at modifying the hazardous and harmful use of alcohol. However, there is a lack of studies on the implementation and evaluation of population-based telephone services for the prevention and treatment of alcohol misuse.Methods/designA randomised controlled trial was designed to compare a brief, structured intervention to usual care within the Swedish National Alcohol Helpline (SAH), concerning their effectiveness on decreasing the hazardous use of alcohol. Between May 2015 and December 2017, about 300 callers are to be individually randomised with a 1:1 ratio to a brief, structured intervention (n = 150) or to usual care (n = 150). The brief, structured intervention consists of the delivery of a self-help booklet followed by one proactive call from SAH counsellors to monitor and give feedback about the client’s progression. Callers assigned to usual care receive telephone counselling according to existing practice, i.e., motivational interviewing in a tailored and client-driven combination of proactive and reactive calls. The primary outcome is defined as a change from a higher to a lower AUDIT risk-level category between baseline and follow-up. General linear modeling will be used to calculate risk ratios of the outcome events. The primary analysis will follow an intention-to-treat (ITT) approach.DiscussionThe trial is designed to evaluate the effectiveness in decreasing the hazardous and harmful consumption of alcohol of a brief, structured intervention compared to usual care when delivered at the SAH. The results of the study will be used locally to improve the effectiveness of the service provided at the SAH. Additionally, they will expand the evidence base about optimal counselling models in population-based telephone services for alcohol misuse prevention and treatment.Trial registrationISRCNT.com, ID: ISRCTN13160878. Retrospectively registered on 18 January 2016.

Factors Associated With Risky Alcohol Consumption Among Male Street Laborers in Urban Vietnam

ABSTRACT Background: Alcohol consumption is of global concern. However, drinking patterns and associated factors remain under-investigated, especially among low socioeconomic groups such as street laborers. Objective: Using the social cognitive model as a framework for the study we aimed to identify factors associated with risky alcohol consumption. Methods: In a cross-sectional study using structured questionnaires, 450 male street laborers searching for casual works in Hanoi, Vietnam were interviewed. A logistic regression was applied in order to detect predictors of risky alcohol drinking. Results: During the last month, 45% of the participants reported daily consumption while the other 55% consumed weekly or less. Among the drinkers (416 out of 450, 92%), 27% were identified as high-risk drinkers who reported more than 14 standard drinks per week, while only 8% were lifetime abstainers. The multivariable logistic regression showed that older age, higher income were positively associated with a higher likelihood of drinking alcohol, while high school level negatively. The environmental predictor was the higher level of peer connection. The association between drinking and risky behavior was found positive with regards to the number of sexual partners. Conclusions: The study suggests that male street laborers are vulnerable to health risks. Decision makers should note that a significant proportion of this target group exceeds the guidelines for alcohol use and this should be included in future interventions or further research. A multisectoral approach together with an important strategy of education is needed to control alcohol use.

Alcohol consumption among adults in Germany: risky drinking levels.

Consuming harmful amounts of alcohol is considered a contributing factor in over 200 diseases. Women who drink over 10 g and men who drink more than 20 g of pure alcohol daily are already consuming risky amounts. According to GEDA 2014/2015-EHIS data, 13.8% of women and 18.2% of men consume risky amounts of alcohol at least weekly. The consumption of potentially dangerous levels of alcohol is most widespread in the 45-64 age group. Across all age groups, the prevalence of risky alcohol consumption patterns is higher among highly educated women compared to women with a lower level of education. For men, this pattern only appears in those aged 65 and over. Preventive measures including social and environmental interventions and responsible drinking campaigns should contribute to further reducing risky alcohol consumption among the population.

Combining alcohol interventions with tobacco addictions treatment in primary care\u2014the COMBAT study: a pragmatic cluster randomized trial

BackgroundTobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program.Methods/designWe will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society’s low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up.DiscussionUpon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice.Trial registrationClinicalTrials.gov NCT03108144

Risky consumption of alcohol and drugs among employees at ski resorts.

Aim:To evaluate risky consumption of alcohol and drugs among Swedish men and women who are employed at ski resorts.Methods:A cross-sectional sample of 611 employees in 48 small and medium-sized enterprises responded to a questionnaire covering alcohol and drug use, social aspects around work and working conditions. Consumption of alcohol and drugs in the study sample was compared to population data. Data were analysed using Mann–Whitney U-tests and logistic regression analyses.Results:Compared to the general population, the study group of ski resort employees had higher scores on the Alcohol Use Disorders Identification Test (AUDIT) in all age groups except 35+ for men. Regarding the Drug Use Disorders Identification Test (DUDIT) scores, only men in the 18–24 age group had higher scores compared to the general population. The prevalence of risky alcohol and drug use was higher among seasonally employed individuals; 82.9%, compared to 58.0% among other employees for alcohol; 8.3% compared to 2.8% for drugs. The regression analysis indicated that social aspects such as living together with colleagues and having co-workers/friends who are frequently inebriated were the most significant explanatory variables for explaining risk consumption of alcohol (OR 16.82 and OR 4.33). Risky use of drugs was associated with being younger (OR 0.15) and male (OR 0.86), as well as with having co-workers/friends who are frequently inebriated (OR 4.25).Conclusions:The study showed a high prevalence of risky alcohol consumption among ski resort employees compared to the general population, with higher risky drug consumption found only among younger men. Social aspects such as living with colleagues and having co-workers or friends who are often inebriated, were identified as important explanatory factors. Preventive measures should be introduced, targeting norms and work culture surrounding alcohol and drug use among ski resort employees.

Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study.

Global health agencies estimate an increase of chronic diseases in South America. Nevertheless, few studies have investigated chronic diseases and their risk factors in the perspective of multimorbidity. This research aimed to identify these aspects in a primary health care setting of central Argentina. The Pan America version of the STEP wise approach surveillance (STEPS) instrument of the World Health Organization was applied to 1044 participants, 365 men and 679 women, with a mean age of 43 years. High prevalence of overweight (33.5%), obesity (35.2%), central obesity (54%), dyslipidemia (43.5%), metabolic syndrome (21.1%), low intake of fruit and vegetables (91.8%), low levels of physical activity (71.5%), risky alcohol consumption (28%), and smoking (22.5%) were detected. Hypertension and diabetes were the most prevalent chronic conditions and the total prevalence of multimorbidity was 33.1%, with 2, 3, 4, 5 and 6 chronic conditions found in 19.9%, 9.1%, 2.6%, 1.1% and 0.4% of the population, respectively. Multimorbidity affected 6.4% of the young, 31.7% of the adults, and 60.6% of the elderly, and was more prevalent among women, and in participants with lower levels of education. Having multimorbidity was significantly associated with obesity, central obesity, and higher concentrations of total blood cholesterol, low-density lipoprotein cholesterol, triglycerides, and glucose. A website was made available to the participants in order to share the experimental results and health-promoting information.

Gender comparison of online and land-based gamblers from a nationally representative sample: Does gambling online pose elevated risk?

The expansion of online gambling opportunities calls for better comprehension of online gambling, including relevant gender specific correlates. This study compared online and land-based gamblers among males and females separately, utilizing a nationally representative Finnish survey sample of 18–74 year olds. Online gamblers were younger than land-based gamblers and had full-time working status more often than land-based gamblers, with partial indication of land-based gamblers' monthly income being lower. Online gambling was associated with participation in computer or video gaming more strongly than with land-based gambling. Results show that the strongest predictors of online gambling common to both genders were younger age, computer gaming and gambling on multiple gambling types. Risky alcohol consumption and tobacco smoking were not associated to gambling mode when controlling for other factors. Results indicate that particularly for females online gambling may be related to higher relative expenditure and at-risk and problem gambling, providing implications for tailored interventions. The continued study of subgroups of gamblers is necessary to comprehensively understand the altering gambling milieu.

Depression and health behaviors in Brazilian adults - PNS 2013.

ABSTRACTOBJECTIVE To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults.METHODS Based on a sample of 49,025 adults (18 to 59 years) from the National Survey on Health 2013 (PNS 2013), we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators), according to the presence of depression (minor and major), evaluated by the Patient Health Questionnaire – 9 (PHQ-9), and the report of depressive mood (in up to seven days or more than seven days) over a two-week period. Prevalence ratios were estimated by Poisson regression.RESULTS Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9), higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65), passive smoking (PR = 1.55), risk alcohol consumption (PR = 1.72), TV for ≥ 5 hours/day (PR = 2.13), consumption of fat meat (PR = 1.43) and soft drink (PR = 1.42). The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood.CONCLUSIONS This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors.

Health risk appraisals in Swedish occupational health services.

BACKGROUND: Health risk appraisals (HRAs) in occupational health services (OHS) in Sweden are very commonly used for health promotion issues, but not much research has explored the extent and nature of individual feedback that is provided.OBJECTIVES: This study aimed to describe and explore HRAs in OHS regarding the content of the feedback in relation to the individual status and overall employee satisfaction.METHODS: Feedback (evaluation and advice) and employee satisfaction with HRA were studied in employees that participated in health risk appraisals with a specific feedback session (HRA-F) (n = 272) and employees that participated in a single session (HRA-S) (n = 104). Associations between feedback and individual status concerning life style were assessed with Cohen’s kappa (k).RESULTS: The employees received mainly information and advice for improvement on health and lifestyle issues (89–100%), while advice for improvement of working conditions was less common (15–59%). The feedback provided on life style was not based on individual status (k < 0.4), except for smoking and risky alcohol consumption (k > 0.55). A great majority of employees reported good overall satisfaction with their HRAs.CONCLUSIONS: The evaluation and feedback given to employees after HRAs should be based more on HRA-results and advice could be focused more on work-related factors.

Regional differences in the prevalence of cardiovascular risk factors in men and women in Germany

More than half of all cardiovascular diseases are caused by eight, mostly preventable risk factors. In view of the considerable differences in the prevalence and mortality of cardiovascular diseases between the 16German federal states, the regional distribution of cardiovascular risk factors was analyzed stratified for men and women, using population-based data. Pooled data (n= 62,606) from the national, telephone health surveys "German Health Update" from 2009, 2010 and 2012 were used to estimate the prevalence of physical inactivity, risky alcohol consumption, smoking, low fruit and vegetable consumption, obesity and diagnosed hypertension, diabetes and dyslipidemia and the accumulated number of risk factors stratified for men and women in the federal states. Furthermore, we analyzed the influence of age and social status on prevalence differences. At the national level, 36.0% of men and 26.6% of women had three or more risk factors. Large differences between men and women were found for risky alcohol consumption (32.8% versus 21.7%), low fruit and vegetable consumption (20.6% versus 10.4%) and current smoking (32.6% versus 24.9%). The prevalence of all eight risk factors differed considerably between federal states. The highest prevalence of physical inactivity, obesity, hypertension and diabetes in both sexes as well as risky alcohol consumption in men were observed in the Eastern federal states (except for Berlin). Sachsen-Anhalt was the only federal state with the highest prevalence for two risk factors. Current smoking was most prevalent in the three federal city states Berlin, Hamburg and Bremen. Saarland had the highest prevalence of low fruit and vegetable consumption in both sexes. Regional differences remained after adjustment for age and social status. There is evidence for regional differences in cardiovascular risk factor levels in Germany that resemble variations in the prevalence and mortality of cardiovascular diseases between federal states with amore unfavorable situation in the East (except for Berlin). Overall, this study shows aconsiderable need for the prevention of mostly modifiable risk factors for cardiovascular diseases in men and women in Germany.

Cannabis, alcohol use, psychological distress, and decision-making style

ABSTRACTIntroduction: There have been suggestions of hypofrontality in cannabis users. To understand cannabis-related differences in decisional processes, Janis and Mann’s conflict model of decision making was applied to recreational cannabis smokers who varied in their alcohol use and level of psychological distress. Method: An online sample of recreational substance users (114 male, 119 female) completed the Melbourne Decision Making Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), Kessler’s Psychological Distress Scale (K10), and the Severity of Dependence Scale (SDS) for cannabis. Results: Multivariate analysis of variance examined self-reported decision-making styles as a function of gender, recent cannabis use, risky alcohol consumption, and levels of psychological distress. Psychological distress was associated with lower decisional self-esteem and higher levels of procrastination and buck-passing. There were gender differences associated with cannabis use. Female cannabis users reported higher levels of hypervigilance, while male cannabis users reported lower levels of buck-passing. Conclusions: Although there was little indication of an avoidant decisional style in cannabis users, the results suggest that cannabis affects decisional processes, contributing to panic in females and impulsivity in males.

Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial

IntroductionGeneral practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is...

Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German Health Interview and Examination Survey for Adults 2008-2011.

ObjectivesThe use and combined use of psychotropic drugs and alcohol among older adults is a growing public health concern and should be constantly monitored. Relevant studies are scarce in Germany. Using data of the most recent national health survey, we analyse prevalence and correlates of psychotropic drug and alcohol use among this population.MethodsStudy participants were people aged 60–79 years (N=2508) of the German Health Interview and Examination Survey for Adults 2008–2011. Medicines used during the last 7 days were documented. Psychotropic drugs were defined as medicines acting on the nervous system (ATC code N00) excluding anaesthetics (N01), analgesics/antipyretics (N02B), but including opiate codeines used as antitussives (R05D). Alcohol consumption in the preceding 12 months was measured by frequency (drinking any alcohol-containing beverages at least once a week/a day) and quantity (alcohol consumed in grams/day; cut-offs: 10/20 g/day for women/men defining moderate and risky drinking). SPSS complex sample module was used for analysis.Results21.4% of study participants use psychotropic medications, 66.9% consume alcohol moderately and 17.0% riskily, 51.0% drink alcohol at least once a week and 18.4% daily, 2.8% use psychotropic drugs combined with daily alcohol drinking. Among psychotropic drug users, 62.7% consume alcohol moderately, 14.2% riskily. The most frequently used psychotropic medications are antidepressants (7.9%) and antidementia (4.2%). Factors associated with a higher rate of psychotropic drug use are female sex, worse health status, certified disability and polypharmacy. Risky alcohol consumption is positively associated with male sex, smoking, upper social class, better health status, having no disability and not living alone.ConclusionsDespite the high risk of synergetic effects of psychotropic drugs and alcohol, a substantial part of older psychotropic drug users consume alcohol riskily and daily. Health professionals should talk about the additional health risks of alcohol consumption when prescribing psychotropic drugs to older adults.

S.03.01 - The dynamics of cannabis use and dependence

Prevalence of substance use and related harms differs across geographic locations, with prevalence increasing with remoteness. This paper builds on previous research, investigating patterns of problematic use by remoteness.Analysis of the National Drug Strategy Household Survey (NDSHS) data from 2007 by geographic location (in accordance with the Australian Standard Geographical Classification (ASGC) remoteness index).Problematic cannabis use was predicted by demographics; older males with less education were more likely to report problematic cannabis use regardless of location. Younger, less educated males in inner regional and remote areas were more likely to report risky alcohol consumption for short term harms, while older, less educated males in outer regional and remote areas were more likely to report daily drinking. People from remote areas were significantly more likely to report driving under the influence of alcohol.It is clear that men with lower levels of education were significantly more likely to report problematic alcohol and cannabis use patterns. An additional level of risk is associated with living in inner regional and remote areas, particularly in relation to risky drinking. Findings suggest a complex relationship between remoteness and substance use which requires further investigation.

Social determinants of mental health service utilization in Switzerland.

To investigate whether mental health services utilization in Switzerland is equitably distributed (i.e., predicted only by the need of a person). Data on 17,789 participants of the Swiss Health Survey 2012 (≥15years) was analysed. Logistic regression analyses were conducted to predict: having been in treatment for a psychological problem; having used psychotropic medication; having had medical treatment for depression; and having visited a psychologist or psychotherapist. Need (depression severity and risky alcohol consumption) and socio-demographic variables were used as independent variables. Depression severity was the strongest predictor for using mental health services. In contrast, risky alcohol consumption was not associated with an increased likelihood of using mental health services. After adjusting for need, the following groups were less likely to use (some of) the mental health services: males, young people, participants who (almost) work full-time, single/unmarried, non-Swiss people and those living in rural areas. Education and income were not significantly associated with the outcomes in the adjusted analyses. Some socio-demographic subgroups are less likely to use mental health services despite having the same need.

Evaluación del consumo de riesgo de alcohol en estudiantes universitarios de la Facultad de Farmacia

Alcohol consumption is highly prevalent in university students. Early detection in future health professionals is important: their consumption might not only influence their own health but may determine how they deal with the implementation of preventive strategies in the future. The aim of this paper is to detect the prevalence of risky alcohol consumption in first- and last-degree year students and to compare their drinking patterns.Risky drinking in pharmacy students (n=434) was assessed and measured with the AUDIT questionnaire (Alcohol Use Disorders Identification Test). A comparative analysis between college students from the first and fifth years of the degree in pharmacy, and that of a group of professors was carried to see differences in their alcohol intake patterns.Risky drinking was detected in 31.3% of students. The highest prevalence of risky drinkers, and the total score of the AUDIT test was found in students in their first academic year. Students in the first academic level taking morning classes had a two-fold risk of risky drinking (OR=1.9 (IC 95%1.1-3.1)) compared with students in the fifth level. The frequency of alcohol consumption increases with the academic level, whereas the number of alcohol beverages per drinking occasion falls.Risky drinking is high during the first year of university. As alcohol consumption might decrease with age, it is important to design preventive strategies that will strengthen this tendency.

Phosphatidylethanol (PEth) detected in blood for 3 to 12days after single consumption of alcohol-a drinking study with 16 volunteers.

In most studies, the alcohol marker phosphatidylethanol (PEth) was used to differentiate social drinking from alcohol abuse. This study investigates PEth's potential in abstinence monitoring by performing a drinking study to assess the detection window of PEth after ingesting a defined amount of alcohol. After 2weeks of abstinence, 16 volunteers ingested a single dose of alcohol, leading to an estimated blood alcohol concentration (BAC) of 1g/kg. In the week after drinking, blood and urine samples were taken daily; in the second week, samples were taken every other day. PEth 16:0/18:1 and 16:0/18:2 were analyzed in blood by online-SPE-LC-MS/MS. Ethyl glucuronide and ethyl sulfate were determined in urine for abstinence monitoring. Prior to start of drinking, PEth 16:0/18:1 exceeded 30ng/mL in blood samples of five volunteers despite the requested abstinence period. Positive PEth values resulted from drinking events prior to this abstinence period. After the start of drinking, maximum BACs were reached after 2h with a mean of 0.80±0.13g/kg (range: 0.61-1.11g/kg). PEth 16:0/18:1 increased within 8h to maximum concentrations (mean: 88.8±47.0ng/mL, range: 37.2-208ng/mL). After this event, PEth was detectable for 3 to 12days with a mean half-life time of approximately 3days. PEth has a potential in abstinence monitoring, since PEth could be detected for up to 12days after a single drinking event. Further investigations are necessary, to establish cut-off levels for PEth as diagnostic marker for the determination of drinking habits like abstinence, social drinking, or risky alcohol consumption.

Prevalência do consumo de risco de álcool no idoso: estudo numa unidade dos cuidados primários da região de Braga

Introduction: Alcohol consumption is associated with risks and benefits depending on the quantity ingested. It is helpful to understand patterns of alcohol consumption in a population in order to decrease risk. The elderly represent a group of special interest, currently under-studied in this area. Family physicians can play a role in the evaluation and prevention of risky alcohol consumption in the elderly. Objectives: To assess the prevalence of risky alcohol consumption in the elderly in a primary care unit. Methods: A cross-sectional study of a sample the clinical records of an 1,225 individuals aged 65 or over was conducted. A representative random sample of 210 elderly patients was selected. Risky consumption was defined as 14 or more standard ethanol units (168g) per week. Results: In this sample of 210 elderly patients, the mean age was 73.7 ± 7.7 years and 57.6 % were women. The prevalence of alcohol consumption was 63% (95% CI 56,69) and risky consumption was found in 32.9% (95% CI 26,39) [56.2% (95% CI 49,62) in men, 15.7% (95% CI 10,20) in women], with 36.7% (95% CI 30,41) of the sample who were abstinent. We found a significant association between male gender and risky alcohol consumption. Age and education were not related to risky consumption. Discussion: In the elderly, excessive consumption of alcohol can have serious consequences. There is a lack of studies to assess patterns of alcohol consumption in this population. We found that 63.3% of the elderly in this population consume alcohol, with a male predominance, similar to findings in national studies. The prevalence of the risky consumption in this population, which includes a third of the sample, is higher than that found in other similar studies. Conclusion: Alcohol risk consumption is prevalent in the elderly in this population and family physicians should be aware of this problem.

Fetal alcohol spectrum disorders (FASD) – diagnosis, neuropsychological assessment, and symptom-orientated therapy

According to the GEDA study (Study of Health in Germany), 20 % of all pregnant women show moderate and 8 % risky alcohol consumption. Of the pregnant women, 12 % engage in binge drinking (≥ 5 drinks per occasion less than once per month, 4 % every month and 0.1 % at least every week). According to conservative estimates, approximately 1 % of all children are affected by intrauterine exposure to alcohol. In total, approximately 800,000 million people, thereof 130,000 children, suffer from a fetal alcohol spectrum disorder in Germany. Many of the affected children, however, remain undiagnosed or are properly diagnosed only very late. To date, professionals in the healthcare and social system have not been sufficiently informed about the symptoms and the necessary diagnosis. This review illustrates the medical and psychological possibilities and necessities regarding children and adolescents with FASD. Early diagnosis and living in a supportive and violence-free environment are the most important protective factors for the long-term outcome of patients with FASD.

Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

BackgroundScreening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI.MethodsSemi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method.ResultsTraining and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro- level such as societal and political culture the effects risks to get nullified.ConclusionsEssential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.Trial registrationClinicalTrials.gov. Trial identifier: NCT01501552.