Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

Objective To evaluate the effectiveness of different brief intervention

strategies at reducing hazardous or harmful drinking in primary care.

The hypothesis was that more intensive intervention would result in a

greater reduction in hazardous or harmful drinking.

Design Pragmatic cluster randomised controlled trial.

Setting Primary care practices in the north east and south east of

England and in London.

Participants 3562 patients aged 18 or more routinely presenting in

primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900

(30.1%) screened positive for hazardous or harmful drinking and 756

(84.0%) received a brief intervention. The sample was predominantly

male (62%) and white (92%), and 34% were current smokers.

Interventions Practices were randomised to three interventions, each

of which built on the previous one: a patient information leaflet control

group, five minutes of structured brief advice, and 20 minutes of brief

lifestyle counselling. Delivery of the patient leaflet and brief advice

occurred directly after screening and brief lifestyle counselling in a

subsequent consultation.

Main outcome measures The primary outcome was patients’ self

reported hazardous or harmful drinking status as measured by the alcohol

use disorders identification test (AUDIT) at six months. A negative AUDIT

result (score <8) indicated non-hazardous or non-harmful drinking.

Secondary outcomes were a negative AUDIT result at 12 months,

experience of alcohol related problems (alcohol problems questionnaire),

health utility (EQ-5D), service utilisation, and patients’ motivation to

change drinking behaviour (readiness to change) as measured by a

modified readiness ruler.

Results Patient follow-up rates were 83% at six months (n=644) and

79% at 12 months (n=617). At both time points an intention to treat

analysis found no significant differences in AUDIT negative status

between the three interventions. Compared with the patient information

leaflet group, the odds ratio of having a negative AUDIT result for brief

advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief

lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis

confirmed these findings.

Conclusions All patients received simple feedback on their screening

outcome. Beyond this input, however, evidence that brief advice or brief

lifestyle counselling provided important additional benefit in reducing

hazardous or harmful drinking compared with the patient information

leaflet was lacking.