World
Health Organization Collaborative Project on Identification and Management
of Alcohol-related Problems in Primary
Health Care
Phase IV
Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care.
Phase III
Phase III of the project was concerned with the conditions necessary for successful dissemination of screening and brief interventions in primary health care. It was divided into three strands which were carried out in several countries across the world, including Australia, Canada, Denmark, Fiji, Hungary, Italy, New Zealand, Norway, Poland and the UK.
Strand 1 was a postal questionnaire survey of GPs' knowledge, practice and attitudes concerning preventive medicine and early alcohol intervention in primary health care. In the UK study, it was found that GPs did not routinely enquire about alcohol and managed only small numbers of patients for excessive drinking or alcohol problems. GPs identified lack of time and training, and lack of help from government policy, as the main barriers to implementation. Similar findings were obtained in other countries.
Saunders, J. & Wutzke, S. (Eds.) (1998). WHO Phase III Collaborative Study on Implementing and Supporting Intervention Strategies in Primary Health Care. Report on Strand 1: General Practitioners’ Current Practices and Perceptions of Preventive Medicine and Intervention for Hazardous Alcohol Use. Copenhagen, Denmark: WHO Regional Office for Europe, Alcohol, Drugs & Tobacco Programme.
Kaner E., Heather N., McAvoy B. et al. (1999). Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol & Alcoholism, 34, 559-66.
Strand 2 of the project was an interview study of key informants' views concerning the barriers to and incentives for preventive medicine and early alcohol intervention in primary health care. In the UK study, government-directed incentives and remuneration for carrying out this type of work, improved medical training on alcohol and preventive medicine, and an easing of workload and administrative pressures in primary care were identified as the main incentives for implementation.
McAvoy, B.R., Donovan, R.J., Jalleh, G. et al. (2001). General practitioners, prevention and alcohol - a powerful cocktail? Facilitators and inhibitors of practising preventive medicine in general and early intervention for alcohol in particular: a twelve nation key informant and general practitioner study. Drugs: Education, Prevention & Policy, 8, 1103-1117.
Strand 3 was a randomised controlled trial to evaluate the effectiveness and cost-effectiveness of different marketing, training and support strategies in the dissemination of a brief intervention package in primary health care. The package used was the Drink-less programme which was developed and tested in Australia. The package comprised: a promotional pamphlet; programme guidelines for GPs and also receptionists; the AUDIT questionnaire (to be completed by the patient); a scoring template for GPs to assess patients' scores quickly; an advice handy-card for GPs to use with patients containing information on safe levels of alcohol, the benefits of cutting down and advice on behaviour change and goal setting; and a self-help booklet for patients to take home.
Results from the four arms of this study that have been published (from Australia, Denmark, New Zealand and UK) are in general agreement that marketing by telephone is the most cost-effective way of disseminating brief interventions among GPs and that training plus ongoing telephone support increases rates of implementation in practise.
Gomel, M, Wutzke, S, Hardcastle, D, Lapsley, H & Reznik. (1998). Cost-effectiveness of strategies to market and train primary primary health care physicians in brief intervention techniques for hazardous alcohol use. Soc. Sci. Med, 47(2) 203-211.
Hansen, L.J., Olivarius, N., Beich, A and Barfod, S. Encouraging GPs to undertake screening and brief intervention in order to reduce problem drinking: a randomised controlled trial. Family Practice. 1999: 16: 551-557.
Kaner, E.F.S., Haighton, C.A., McAvoy, B.R., Heather, N. & Gilvarry, E. (1999). A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners. British Journal of General Practice, 49, 699-703.
Lock, C, Kaner, EFS, Heather, N, McAvoy, B, Gilvarry, E. A randomized trial of three marketing strategies to disseminate a screening and brief alcohol intervention programme to general practitioners. British Journal of General Practice. 1999: 49;695-698.
McCormick, R., Adams, P., Powell, A., Bunbury, D., Paton-Simpson, G. & McAvoy, B. (1999). Encouraging general practitioners to take up screening and early intervention for problem use of alcohol: a marketing trial. Drug & Alcohol Review, 18, 171-177.
Monteiro, M G. & Gomel, M. (1998) World Health Organization project on brief interventions for alcohol-related problems in primary health care settings. Journal of Substance Abuse. 3, 5-9
For more information about Phase III Projects, please see the references below:
Gomel, M.K., Saunders, J.B., Burns, L., Hardcastle, D.M., & Sumich, M. Dissemination of early intervention for harmful alcohol consumption in general practice. Health Promotion J Aust. 1994: 4; 65-69.
Wutzke, S.E, Gomel, M.K., & Donovan, R. Enhancing the delivery of brief interventions for hazardous alcohol use in the general practice setting: a role for both GPs and the medical receptionists. Health Promotion J Aust. 1998: 8(2); 105-108.
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