Alcohol Treatment Matrix cell C1: Management/supervision; Screening and brief intervention

2020/21 update funded by

Alcohol Change UK web site. Opens new Window

Alcohol Change UK

Previously also funded by

Society for the Study of Addiction web site Society for the Study of Addiction

Developed with

Skills Consortium web site. Opens new window

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Management/supervision; Screening and brief intervention

Seminal and key studies on management and supervision in screening and brief interventions for risky drinking. Highlights UK guidance which insists health service managers “must” support this work and the quandary over whether to insist on these procedures (taking time which could have been used in other ways) or to let practitioners and patients decide their priorities. See the rest of row 1 of the matrix for more on screening and brief interventions.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S Ongoing support needed for GPs to screen and advise (2005). World Health Organization trial in England and five other countries conducted in the late 1990s found personal contact and ongoing support as well as training were needed even to achieve modest levels of implementation by GPs. In England (1999) training plus support was the most cost-effective strategy, but still few doctors implemented the programme.

S Training plus ongoing support also best for primary care nurses (2003; free source at time of writing). Also in English primary care practices and at about the same time, as with GPs (study above) training plus support was found the most cost-effective strategy for engaging practice nurses, but still few patients were screened and advised. Research reports (2001) also freely available. For discussion click and scroll down to highlighted heading.

K Strong incentives and automatic reminders can dramatically increase screening and intervention rates (2010). Use this entry as your gateway to studies of the US ‘VA’ health care service for ex-military personnel, which showed that near universal screening is possible in primary care and that many more risky drinkers are counselled when electronic prompts are backed by management. Questions remained over quality (2011) and no reliable impacts on drinking were detected in the featured study or across (2014) the VA system. Related review below. For discussions click here and here and scroll down to highlighted headings.

K Near universal screening possible in emergency departments (2013; free source at time of writing). Integrating screening questions into the emergency triage system of a major US trauma department (where alcohol screening and brief advice are required) led to 97% of patients being screened and 60% who screened positive being advised about their drinking.

K Dutch primary care implementation drive may have been counterproductive (2012). At Dutch general practices which had been offered comprehensive training and support to implement brief interventions, risky-drinking patients were slightly less likely to remit to non-risky drinking than at comparison practices. Implementation rates (2012; free source at time of writing) were also poor, not significantly better among practices targeted with training and support, and fell back once these inputs ended. Possibly part of the explanation is that the programme did not significantly bolster (2014) doctors’ feelings that that knew enough and had the skills to do alcohol-related work and that this was a ‘legitimate’ activity.

K Multi-behaviour change training for GPs not shown to impact on patient drinking and other lifestyle risks (2013) Bundling training for GPs on brief advice for drinking with similar advice on smoking, diet and exercise meant more patients were addressed about these behaviours and more tried to change them, but success rates generally and in respect of drinking were not significantly improved compared to patients at untrained practices.

K Research report (2016) and article (2016) on the role of training in delivering alcohol screening and brief interventions beyond usual medical settings to areas such as social and community services and policing. Based partly on a survey and interviews gaining the views of trainees in four English regions, which revealed that implementation levels remained low after training, partly because screening in particular was often felt inappropriate to the working context. Recommendations made for adapting training.

R Implementation programmes for primary care have modestly boosted implementation rates (2015; free source at time of writing). Synthesis of results from 29 trials found implementation efforts had boosted both screening and brief intervention rates but not significantly affected drinking. Greatest impacts were seen from multi-strand strategies addressing the organisation and/or the patient as well as the clinician, and screening benefited from involving staff such as nurses as well as doctors. For discussions click here and here and scroll down to highlighted headings.

R Accountability and feedback raise screening rates in primary care (2011). Found that the three most successful screening implementation efforts (including by the US ‘VA’ service for ex-military personnel; study listed above) used electronic medical records to make staff aware of and accountable for their screening performance. How subsequent advice-giving rates could be improved was unclear, perhaps because intervention is more a matter of clinical judgement and priorities. For discussion click and scroll down to highlighted heading.

R Managerial action key to boosting implementation, finds review for NICE (2011). Assessment for the UK’s health technology regulator highlights financial support, training, managing workload, incentives, and leadership which not only ‘preaches’ the need for screening/brief advice but uses management levers to ensure it happens. Notes that current UK strategy of screening when lifestyle issues are commonly addressed (eg, registering new patients, well-being clinics) goes with the grain of staff and patients’ expectations. For discussions click here and here and scroll down to highlighted headings.

R Education and support not enough to embed screening and brief intervention (2008). Without management direction or incentives, education, training and support organised by researchers still left tiny proportions screened. See from page 8 for implementation trials in UK primary care practices. For discussions click here and here and scroll down to highlighted headings.

G In both its prevention (NICE, 2010) and treatment (NICE, 2011) guidance on addressing drinking, the UK’s health technology regulator stresses that managers of NHS-commissioned services “must” ensure staff have enough training, time and resources to effectively carry out evidence-based screening and brief advice. For discussions click here and here and scroll down to highlighted headings.

G Screening and brief intervention training for England (Public Health England, accessed August 2019). Web-based courses for primary care, pharmacies, hospitals and dental teams, based on “the robust evidence-base of more than 60 controlled trials over 30 years” which, says England’s public health authority, shows that a few minutes’ advice reduces health risks from drinking.

G UK guidance on when and when not to be very brief (2013). Explains the different types of ‘brief interventions’ and when to offer just five minutes of simple advice, or to start with or step up to more extended interventions; identifies the pros and cons and the required time, training and staff.

G Three guides from the UK national charity Alcohol Concern (now absorbed into Alcohol Change UK) supported by the Safe Sociable London Partnership and Public Health England, focusing on: community health settings (2015) such as primary care, pharmacies, and drug services; hospitals (2015) including emergency departments; and criminal justice services (2015) including police, probation and prisons. Each recommends minimum standards for this work and suggests brief interventions are based on the FRAMES principles.

G Step-by-step guide to a successful programme mounted in London (World Health Organization, 2009). Turn to page 195 of the downloaded PDF (the whole document is titled Alcohol and injuries: emergency department studies in an international perspective) for a description of the programme which reduced (2004) drinking and re-attendances at an inner-London emergency department, an evaluation discussed in cell A1.

G UK screening and brief intervention implementation aids and guidance (accessed July 2019). Web site offers discussion, news, and a portal to screening instruments and guides on how to advise patients.

G WHO training manual for Europe (World Health Organization, 2018). Developed for member nations of the European Union to help them expand and improve the training of health professionals on alcohol screening and brief intervention, based on an international expert consensus. How to organise a training programme plus interactive activities and role plays to develop practitioners’ skills.

G US resources and guidance on screening and brief intervention ([US] Substance Abuse and Mental Health Services Administration, accessed August 2019). US guidance and resources to support the national ‘SBIRT’ programme of screening and brief intervention including implementation, management, and staff training in a variety of health and other service settings.

G US guides on implementing screening and brief interventions for emergency departments ([US] Emergency Nurses Association, 2008), trauma centres ([US] Centers for Disease Control and Prevention and National Center for Injury Prevention and Control, 2009), primary care and mental health clinicians ([US] National Institute on Alcohol Abuse and Alcoholism, 2005), primary care practices (American Academy of Family Physicians, 2019; funded by US Department of Health) and community health workers (American Public Health Association for US Department of Transportation, 2008).

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page. See also hot topic on brief interventions.

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