Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five country cluster randomized factorial trial

Aims: To test if training and support of primary health care providers (PHCP), financial reimbursement to PHCP for screening and brief advice, and option for PHCP to refer screen positive patients to an internet-based method of giving advice (eBI) increases PHCP’s delivery of screening and advice to heavy drinkers, compared to a control group of PHCPs.

Design: Cluster randomized factorial trial with 12-week implementation measurement period.

Setting: Primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden.

Participants: 120 PHCU, 24 in each of Catalonia, England, Netherlands, Poland and Sweden.

Interventions PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR), and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.

Outcome measures Primary outcome measures is proportion of eligible patients screened during a 12-week implementation period. Secondary outcome measures are proportion of screen positive patients advised; and, proportion of consulting adult patients given an intervention (screening and advice to screen positives) during the same 12-week implementation period.

Results During a 4-week baseline measurement period, 5.9 (95% CI 3.4 to 8.4)per 100 adult patients consulting per PHCU were screened for their alcohol consumption. Based on the factorial design, PHCU that received TS had a 1.48 (95% CI 1.13 to 1.95)relatively higher proportion of patients screened during the 12-week implementation period than PHCU that did not receive TS; PHCU that received FR had a 2.00 (95% CI 1.56 to 2.56) relatively higher proportion than no FR. The option of referral to eBI did not have a higher proportion. A combination of TS plus FR had a 2.34 (95% CI 1.77 to 3.10) relatively higher proportion of patients screened than no TS plus FR. A combination of TS plus FR plus eBI had a 1.68 (95% CI 1.11 to 2.53) relatively higher proportion of patients screened than no TS plus FR plus eBI.

Conclusions Training and support of PHCP, and financial reimbursement to PHCP for screening and brief advice increase the proportion of adult patients screened for their alcohol consumption, at least in the short term.