Alcohol Drinking Clinical Trial
Official title:
Engaging General Practice in the Prevention of Patients With Alcohol Problems
The aim of the study is to test whether or not a tailored multi-component intervention
program to increase the activity of general practice teams in the prevention of hazardous
and harmful alcohol consumption results in increase advice giving rate to patient with
hazardous and harmful alcohol consumption and a better patient outcome in terms of hazardous
and harmful alcohol consumption.
The primary objectives of the proposed study are:
1. to test the (cost) effectiveness of a tailored multi-component implementation program
to engage general practices (i.e. GPs, nurse practitioners or practice
nurses/assistants) in the prevention of hazardous or harmful alcohol consumption,
changing both providers' advice giving behaviour and patients' alcohol consumption
2. to identify predictors of effect
3. to examine whether or not the implementation of a tailored multi-component
implementation program to engage general practice in the prevention of hazardous or
harmful alcohol consumption is feasible.
Hazardous and harmful alcohol consumption is likely to cause damage to health, either
physical or mental. The prevention of harmful alcohol consumption results in a reduction of
alcohol related diseases, of emergency and hospital use, and of societal related problems,
and it results in direct health care savings as well as in non-health care savings. General
practice is an important setting to intervene with patients whose drinking is hazardous or
harmful to their health. Despite the evidence for the efficacy and cost effectiveness of
case finding and brief interventions in general practice, such interventions are rarely
integrated into routine practice. Based on the literature it is recommended to develop a
tailored multi-component implementation program to engage general practice in the prevention
of patients with alcohol consumption.
In our trial such a tailored multi-component intervention program is offered to the general
practice team (GPT). The participants in our trial are the GPT, not the patients. The GPTs
practising in Mid-West and Mid-South are invited to participate in the trial by an
invitational letter, including an information leaflet. Participation is not obligatory, but
based on own interest of the GPT. Next, GPTs who are willing to participate in the trial are
random allocated to the intervention or control condition. Besides the effect outcome
measures described in the 'Outcome measure" part there are process and costs measures
described.
Besides measurements at the GPT-level, we also conduct measurements at the patient level.
All patients of 18 years or older visiting the GPT during a pre-defined 3-month period are
asked to fill in the Alcohol Use Disorders identification Test (AUDIT). This measurement
takes place before the intervention starts. Only those patients at risk are asked to fill in
the AUDIT after the intervention ended. As described in the 'Outcome part', the AUDIT is
used to describe the effects of the intervention program at the patient level. Patients
receive individual feedback with personal advice depending on their AUDIT score. Patients
are not informed about whether the GPT is allocated to the intervention program or control
condition (usual care) (single blind).
Comparison: GPTs participated in the multi-component intervention program (see
Interventions; intervention group) are compared to GPTs who didn't participate in the
multi-component intervention program (control group). The GPTs in the control group receive
the NHG guideline and NHG patient information letters, which can be seen as usual care. In
addition the receive feedback about the number of patients at risk because of their alcohol
consumption, which can be seen as a minimal intervention.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Open Label
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