Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary health care secondary analyses of data from the ODHIN five country cluster randomized factorial trial

Background The implementation of primary health care-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. Objectives Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and, the extent to which training mitigates any differences due to such characteristics found at baseline. Methods A cluster randomized factorial trial involving 120 practices, 746 providers and 46,546 screened patients from Catalonia, England, Netherlands, Poland and Sweden. Practices were randomized to receive training or to not receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen positive patients advised. Results Nurses tended to screen more patients than doctors (OR=3.1; 95% CI 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than nurses (OR=2.3; 95% CI 1.4, 4.1), and more likely to be advised the higher their risk status (OR=1.9; 95% CI 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high risk status. Conclusion Training primary health care providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552