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What do primary care clinicians think would help them bridge the ‘implementation gap’ in screening for risky drinking and brief advice, and extend the potential benefits to a greater proportion of the population? A European trial found the answer differed depending on distinctive national circumstances.
STUDY 2019 HTM file
Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis
The clearest impact of financial incentives to screen primary care patients in England was the plummeting screening rate after the incentives were withdrawn. If these results are applicable to England as a whole, over the following 21 months withdrawing the payments resulted in 603,719 fewer patients being screened for risky drinking and 27,439 fewer receiving brief advice.
REVIEW 2019 HTM file
Supervised consumption sites: a nuanced assessment of the causal evidence
How high should the evidence bar be set when deciding whether to endorse drug consumption rooms?
People with co-occurring mental health and substance use problems are often unable to access the care they need. This 2017 guide from Public Health England describes what better care would look like, underpinned by the principles that there is ‘no wrong door’ for accessing support, and it is ‘everyone’s job’ the other side of the door to help.
STUDY 2016 HTM file
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
The EU-funded ODHIN trial tested eight strategies to promote screening and brief interventions for risky drinking in primary health care units in five European countries. Results suggested that financial incentives were key but were reinforced by training and support.
Could combinations of three strategies – training and support, financial reimbursement, and the opportunity to refer patients to a website – cost-effectively boost delivery of brief interventions in European primary care? The important aim was to find the best way to narrow the ‘implementation gap’ between the number of patients who could benefit from these interventions and those who receive them.
In these UK national prevention guidelines, experts prioritised population-wide changes like price rises and outlet restrictions which affect everyone, independent of the choices they make. But in England government prefers to target what they see as the troublesome minority, not the responsible majority.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell D4: Organisational functioning; Psychosocial therapies
Key studies on how treatment organisations affect the implementation and effectiveness of psychosocial therapies for drug dependence. See if you agree that “organizational climate underlies the entire process of innovation adoption”, appreciate the obstructive effect of high staff turnover and how to reduce it, ask yourself, “Is my service even ready for change?” – and explore whether change driven by money is just as good for patients as that motivated by a desire to improve their lives.
DOCUMENT 2017 HTM file
Commissioning impact on drug treatment: The extent to which commissioning structures, the financial environment and wider changes to health and social welfare impact on drug misuse treatment and recovery
Based on research, financial data and stakeholder surveys and testimonies, the UK government’s official drug policy advisers warn that without significant efforts to protect investment and quality, in England “loss of funding will result in the dismantling of a drug misuse treatment system that has brought huge improvement to the lives of people with drug and alcohol problems”.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell E2: Treatment systems; Generic and cross-cutting issues
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing drug addiction treatment. Commentary focuses on payment-by-results funding mechanisms, crime-reduction as a justification for treatment, and ways to improve treatment systems, especially the core care planning process.
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