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‘A minute makes a difference in primary care consultations’, was the finding of a 1992 study about improving the capacity of general practitioners to screen for problems such as heavy drinking, smoking, and high blood pressure. But is extra time on the clock enough to secure routine (as opposed to more frequent) delivery of health promotion and brief intervention?
MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell D1: Organisational functioning; Screening and brief intervention
Seminal and key studies on how organisational functioning affects screening and brief intervention. Highlights a striking illustration of the importance of organisational context emerging from the unprecedented implementation drive at the US health care system for ex-military personnel. See the rest of row 1 of the matrix for more on screening and brief interventions.
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.
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.
Simulation study calculated health care cost savings and benefits for patients in England which make routine GP-based screening and brief advice for excessive drinking look an unmissable bargain, but the key assumptions derived from studies divorced from how interventions would routinely be implemented.
In the context of current UK policy, this is a key study, testing the ambition to extend recovery beyond formal treatment by systematically linking patients to mutual aid groups, the main way it is being suggested commissioners can square the circle of doing more (recovery is seen as a whole-life transformation) with less.
STUDY 2017 HTM file
Impact of financial incentives on alcohol consumption recording in primary health care among adults with schizophrenia and other psychoses: a cross-sectional and retrospective cohort study
UK study of how Quality and Outcomes Framework incentives for primary care boosted alcohol screening among patients with severe mental illness shows what could have happened had the incentives been extended across the entire primary care caseload.
Coinciding with a ‘refresh’ of Scotland’s alcohol strategy, evidence that financial incentives in primary care can affect delivery of brief alcohol interventions.
Interventions delivered by nurses did lead to a reduction in excessive drinking in their patients, but there seemed to be no advantage of a structured brief intervention over standard advice.
STUDY 2016 HTM file
Monitoring and evaluating Scotland’s alcohol strategy: Final annual report
The final report evaluating Scotland’s alcohol strategy concludes that while some evidence-based interventions have been implemented, failure to implement minimum unit pricing is likely to have limited the strategy’s contribution to declines in both alcohol consumption and related harm.
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