Trial Testing the Effect of Strategies on Performance of Brief Intervention Programmes for Harmful Alcohol Consumption (ODHIN_RCT)

• Number of screening tests carried out in primary health care settings to detect excessive alcohol consumption care [ Time Frame: 5 months ] [ Designated as safety issue: No ]
  Screening rates will be calculated at five time points: during a four week period during the third month before the start of the study (baseline measurement), in three consecutive four week blocks during the twelve week intervention period (intervention measurement) and during a four week block during the sixth month after the end of the intervention period (follow-up measurement).
• Number of brief interventions for excessive alcohol consumption delivered in primary health care settings [ Time Frame: 5 months ] [ Designated as safety issue: No ]
  Brief intervention rates will be calculated at five time points: during a four week period during the third month before the start of the study (baseline measurement), in three consecutive four week blocks during the twelve week intervention period (intervention measurement) and during a four week block during the sixth month after the end of the intervention period (follow-up measurement).

• Level of role security of primary health care providers measured by their answers to the SAAPPQ instrument [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Role security of the primary health care providers will be measured through their responses to the SAAPPQ (a validated instrument based on factor analysis (Anderson & Clement 1987) of the original alcohol and alcohol problems perception questionnaire developed and validated by Cartwright (1980))at three time points: baseline, end of intervention period, and follow-up.
• Level of therapeutic commitment of primary health care providers measured by their answers to the SAAPPQ instrument [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Therapeutic commitment of the primary health care providers will be measured through their responses to the SAAPPQ (a validated instrument based on factor analysis (Anderson & Clement 1987) of the original alcohol and alcohol problems perception questionnaire developed and validated by Cartwright (1980))at three time points: baseline, end of intervention period, and follow-up.

The overall objective is to study if training and support, financial reimbursement and referral to an internet based brief intervention programme, singly or in combination, may increase implementation of evidence based methods of identification and brief intervention for excessive alcohol consumption in routine primary health care.

The study will be a stepped cluster RCT in 5 countries and the endpoint of the study is the number of interventions delivered during a certain time period. More specifically, the RCT will examine:

• The effect of Continuous Medical Education (CME) to PHC providers
• The effect of financial reimbursement to PHC providers as a pay-for-performance of brief alcohol interventions
• Whether an alternative internet based method of delivering brief intervention can increase the proportion of patients reached
• If one implementation strategy will give an added value to one already enforced.

• Other: Training and support (T&S)
  Two face-to-face educational meetings of at least one hour and a maximum of 2 hours, and one telephone support call of at least ten minutes and a maximum of 30 minutes. The telephone call will be offered to one of the GPs ('leader'). Depending on the needs of the PHCU, one additional face to face training (1 to 2 hours) may be offered. The time interval between meetings will be on average 2 weeks. The training sessions will address improving knowledge, skills, attitudes, and perceived barriers and facilitators by combining theory and practice-based training.
• Other: Financial incentive
  Groups will receive a financial incentive depending on their screening and brief intervention activities. They will be paid for the performance, with the country dependent system of pay (fee for item or fee for achieving set rates) and based on normal practices and financial rates for financial incentives for clinical preventive activities.
• Other: E-SBI (online screening and brief intervention)
  Referring identified at-risk patients to an approved e-SBI programme, which will be either country specific (where these exist) or based on the WHO e-SBI programme (Poland).

• No Intervention: Treatment as usual
  In the no-intervention treatment as usual group, a package, containing a summary card of the national guideline recommendation, will be delivered to each provider unit without demonstration. In Poland, the summary card will be adapted from the PHEPA guidelines (ref) for the purposes of this trial. The treatment as usual group will be requested to screen and offer person-to-person SBI at the PHCU.
• Experimental: Training & support (T&S)
  The T&S only group will be offered two face-to-face educational meetings of at least one hour and a maximum of 2 hours, and one telephone support call of at least ten minutes and a maximum of 30 minutes. The telephone call will be offered to one of the GPs ('leader'). Depending on the needs of the PHCU, one additional face to face training (1 to 2 hours) may be offered. The time interval between meetings will be on average 2 weeks. The training sessions will address improving knowledge, skills, attitudes, and perceived barriers and facilitators by combining theory and practice-based training.
  Intervention: Other: Training and support (T&S)
• Experimental: Financial incentive
  The financial incentive only group will receive a financial incentive depending on their screening and brief intervention activities. They will be paid for the performance, with the country dependent system of pay (fee for item or fee for achieving set rates) and based on normal practices and financial rates for financial incentives for clinical preventive activities.
  Intervention: Other: Financial incentive
• Experimental: E-SBI
  The e-SBI (online screening and brief intervention)only group are expected to refer identified at-risk patients to an approved e-SBI programme, which will be either country specific (where these exist) or based on the WHO e-SBI programme (Poland).
  Intervention: Other: E-SBI (online screening and brief intervention)
• Experimental: T&S and financial incentive
  The T&S and financial incentive group will be offered two face-to-face educational meetings of at least one hour and a maximum of 2 hours, and one telephone support call of at least ten minutes and a maximum of 30 minutes. Also, they will receive a financial incentive depending on their screening and brief intervention activities. They will be paid for the performance, with the country dependent system of pay (fee for item or fee for achieving set rates) and based on normal practices and financial rates for financial incentives for clinical preventive activities.
  Interventions:

  • Other: Training and support (T&S)
  • Other: Financial incentive
• Experimental: T&S and e-SBI
  The T&S and e-SBI group will be offered two face-to-face educational meetings of at least one hour and a maximum of 2 hours, and one telephone support call of at least ten minutes and a maximum of 30 minutes. The telephone call was offered to one of the GPs ('leader'). Depending on the needs of the PHCU, one additional face to face training (1 to 2 hours) was offered. Also this group is expected to refer identified at-risk patients to an approved e-SBI (online screening and brief intervention) programme, which will either be country specific (where these exist) or based on the WHO e-SBI programme (Poland).
  Interventions:

  • Other: Training and support (T&S)
  • Other: E-SBI (online screening and brief intervention)
• Experimental: Financial incentive and e-SBI
  The financial incentive and e-SBI (online screening and brief intervention) group will be paid for screening and referral performance instead of actual delivery of e-SBI by themselves as in line with the e-SBI only group, with the country dependent system of pay (fee for item or fee for achieving set rates) and based on normal practices and financial rates for financial incentives for clinical preventive activities.
  Interventions:

  • Other: Financial incentive
  • Other: E-SBI (online screening and brief intervention)
• Experimental: T&S, financial incentive and e-SBI
  The T&S, financial incentive and e-SBI (online screening and brief intervention) group will be offered two face-to-face educational meetings of at least one hour and a maximum of 2 hours, and one telephone support call of at least ten minutes and a maximum of 30 minutes. The telephone call will be offered to one of the GPs ('leader'). Also, they are expected to offer screening at the PHCU and to refer screen positive patients to e-SBI programmes. Additionally, they will be paid for screening and referral performance, with the country dependent system of pay (fee for item or fee for achieving set rates) and based on normal practices and financial rates for financial incentives for clinical preventive activities.
  Interventions:

  • Other: Training and support (T&S)
  • Other: Financial incentive
  • Other: E-SBI (online screening and brief intervention)

Inclusion Criteria:

• Primary Health Care Units (PHCU) of approximate size of 5.000-20.000 registered patients
• Primary Health Care Units (PHCU) located in Spain, Poland, Sweden, England or The Netherlands
• Providers must be physicians or nurses

Exclusion Criteria:

• Primary Health Care Units with less than 5.000 registered patients or over 20.000 registered patients

• European Commission
• Stichting Katholieke Universiteit
• University of Newcastle Upon-Tyne
• King's College London
• Goeteborgs Universitet
• Linkoeping University
• Departament de Salut de la Generalitat de Catalunya
• Panstwowa Agencja Rozwiazywania Problemow Alkoholowych
• University College, London
• Maastricht University
• Pomorski Uniwersytet Medyczny w Szczecinie