Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial

PURPOSE We aimed to test whether 3 strategies—training and support, financial reimbursement, and an option to direct screen-positivepatients to an Internet-based method of giving brief advice—have a longer-term effect on primary care clinicians’ deliveryof screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C)tool.
METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughoutCatalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); trainingand support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions;and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receivingintervention—screening and, if screen-positive, advice—at 9 months.
RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-upwas 1.39 (95% CI, 1.03–1.88) in units that received training and support as compared with units that did not. Neither financialreimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention.
CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patientsgiven an alcohol intervention at 9 months.