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HOT TOPIC 2017 HTM file
‘My GP says I drink too much’: screening and brief intervention
One of our hot topics – important issues which sometimes generate heated debate. In the absence of more or less inescapable impediments to heavy drinking like ramping up the price of cheap alcohol, widespread screening and brief advice have been the great hope for drink-related public health improvements. Patchy effectiveness and poor implementation have led that ambition to be questioned.
When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling, yet at a service for US ex-military personnel the reminder was rarely used and made no difference to patients' drinking. Why were results so different from those at other clinics?
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.
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.
MATRIX CELL 2019 HTM file
Alcohol Treatment Matrix cell E1: Treatment systems; Screening and brief intervention
Key studies and reviews on local, regional and national systems for implementing alcohol screening and brief intervention. Context is that Britain’s National Institute for Health and Care Excellence insists commissioners and managers “must” provides the resources needed for brief intervention to become part of everyday work. Can these interventions be widely implemented, and even if they are, will they improve public health? See the rest of row 1 of the matrix for more on screening and brief interventions.
REVIEW 2018 HTM file
Effectiveness of brief alcohol interventions in primary care populations
Update of a key document forming the basis of claims that brief interventions work in ‘real-world’ settings. Combined findings from randomised trials confirm that brief advice in primary care can reduce drinking, but will those reductions be realised in contemporary routine practice?
This huge US study set out to test whether widespread screening and brief intervention for illegal drug use (not just heavy drinking) could be implemented in a variety of general medical settings and whether it was effective. Both tests seem to have been passed, but with some important caveats.
No matter which dissemination strategy was tried, just 4 in 10 GPs in Germany logged in to a government funded online alcohol intervention education and support system. Even among the few practices who joined the study, training was poorly attended.
OFFCUT 2004 PDF file 89Kb
Controversy over screening primary care patients for risky drinking
Just when a World Health Organisation project was seeking to persuade GPs to screen primary care patients for risky drinking, this hotly contested study concluded that universal screening was an ineffective use of health care resources.
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