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When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling. In one service for US ex-military personnel, this resulted in nearly three quarters of patients being counselled and a hint of consequentially reduced drinking; at another, findings were negative. Why the difference?
From Brazilian primary care clinics a rare confirmation that a positive organisational climate featuring commitment to staff professional development and good links with the local community is associated with overcoming barriers to widely implementing screening and brief intervention programmes.
Applying a systematic and comprehensive framework to map the strategies trialled in attempts to implement screening and counselling for risky drinking primary care patients gives some clues to what it has taken to achieve a high screening rate, the essential first step in the process.
Evaluated across an entire region, a determined effort to implement alcohol screening and brief intervention in the US health system for ex-military personnel led to no significant reductions in drinking – results seen as a prime example of the disappointing impacts of alcohol brief interventions in real-world conditions.
Swiss study of brief alcohol interventions with a representative sample of heavy drinking young men exposed the determining influence on later drinking of the practitioner’s competence in motivational interviewing and how they behave in the session.
STUDY 2014 HTM file
The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR)
A major study conducted in London did not find clinically important reductions in drinking among excessive drinkers offered a brief intervention while attending sexual health clinics, nor did brief intervention seem a cost-effective use of health service resources.
Already delivering alcohol advice to young people as part of the curriculum, did UK secondary schools see a reduction in risky drinking after supplementing it with brief counselling sessions?
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.
HOT TOPIC 2018 HTM file
Computerised therapies: sacrificing effectiveness for wider access?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Among culturally accepted vehicles for delivering substance use interventions, computers, mobile phones and tablets are joining face-to-face work. Are we sacrificing effectiveness for convenience and economy?
The primary care arm of the largest alcohol screening and brief intervention study yet conducted in Britain found that the proportion of risky drinkers fell just as much after the most minimal of screening and intervention methods as after more sophisticated and longer (but still brief) alternatives.
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