Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis

Hdl Handle:
http://hdl.handle.net/10149/581572
Title:
Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis
Authors:
Keurhorst, M. (Myrna); van de Glind, I. (Irene); Bitarello do. Amaral-Sabadini, M. (Michaela); Anderson, P. (Peter); Kaner, E. (Eileen); Newbury-Birch, D. (Dorothy); Braspenning, J. (Jozé); Wensing, M. (Michel); Heinen, M. (Maud); Laurant, M. (Miranda)
Affiliation:
Teesside University, Health and Social Care Institute.
Citation:
Keurhorst, Myrna; van de Glind, Irene; Bitarello do. Amaral-Sabadini, Michaela; Anderson, Peter; Kaner, Eileen; Newbury-Birch, Dorothy; Braspenning, Jozé; Wensing, Michel; Heinen, Maud; Laurant, Miranda (2015) 'Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis' Addiction; Online first 18 Sep 2015 : DOI: 10.1111/add.13088
Publisher:
Wiley
Journal:
Addiction
Issue Date:
2015
URI:
http://hdl.handle.net/10149/581572
DOI:
10.1111/add.13088
Additional Links:
http://doi.wiley.com/10.1111/add.13088
Abstract:
Background and Aims Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake andmeasure impact on: (1) heavy drinking and (2) delivery of SBI in PHC.Methods Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. Results The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients’ reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)= –0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28–0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27–1.02).Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients’ alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). Conclusions To increase delivery of alcohol screening and brief interventions and decrease patients’ alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.
Type:
Article
Language:
en
Keywords:
Brief intervention; implementation; meta-analysis; prevention of heavy alcohol consumption; primary health care; screening; systematic review
ISSN:
09652140
Rights:
Author can archive post-print (ie final draft post-refereeing) subject to 12 months embargo. For full details see http://www.sherpa.ac.uk/romeo [Accessed 03/11/2015]

Full metadata record

DC FieldValue Language
dc.contributor.authorKeurhorst, M. (Myrna)en
dc.contributor.authorvan de Glind, I. (Irene)en
dc.contributor.authorBitarello do. Amaral-Sabadini, M. (Michaela)en
dc.contributor.authorAnderson, P. (Peter)en
dc.contributor.authorKaner, E. (Eileen)en
dc.contributor.authorNewbury-Birch, D. (Dorothy)en
dc.contributor.authorBraspenning, J. (Jozé)en
dc.contributor.authorWensing, M. (Michel)en
dc.contributor.authorHeinen, M. (Maud)en
dc.contributor.authorLaurant, M. (Miranda)en
dc.date.accessioned2015-11-03T12:03:08Zen
dc.date.available2015-11-03T12:03:08Zen
dc.date.issued2015en
dc.identifier.citationAddiction; Online first 18 Sep 2015 : DOI: 10.1111/add.13088en
dc.identifier.issn09652140en
dc.identifier.doi10.1111/add.13088en
dc.identifier.urihttp://hdl.handle.net/10149/581572en
dc.description.abstractBackground and Aims Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake andmeasure impact on: (1) heavy drinking and (2) delivery of SBI in PHC.Methods Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. Results The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients’ reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)= –0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28–0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27–1.02).Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients’ alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). Conclusions To increase delivery of alcohol screening and brief interventions and decrease patients’ alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.en
dc.language.isoenen
dc.publisherWileyen
dc.relation.urlhttp://doi.wiley.com/10.1111/add.13088en
dc.rightsAuthor can archive post-print (ie final draft post-refereeing) subject to 12 months embargo. For full details see http://www.sherpa.ac.uk/romeo [Accessed 03/11/2015]en
dc.subjectBrief interventionen
dc.subjectimplementationen
dc.subjectmeta-analysisen
dc.subjectprevention of heavy alcohol consumptionen
dc.subjectprimary health careen
dc.subjectscreeningen
dc.subjectsystematic reviewen
dc.titleImplementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysisen
dc.typeArticleen
dc.contributor.departmentTeesside University, Health and Social Care Institute.en
dc.identifier.journalAddictionen
or.citation.harvardKeurhorst, Myrna; van de Glind, Irene; Bitarello do. Amaral-Sabadini, Michaela; Anderson, Peter; Kaner, Eileen; Newbury-Birch, Dorothy; Braspenning, Jozé; Wensing, Michel; Heinen, Maud; Laurant, Miranda (2015) 'Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis' Addiction; Online first 18 Sep 2015 : DOI: 10.1111/add.13088en
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
dc.contributor.institutionIndependent consultant in public health; Brazilen
dc.contributor.institutionNewcastle University; Institute of Health and Society; Newcastle UKen
dc.contributor.institutionNewcastle University; Institute of Health and Society; Newcastle UKen
dc.contributor.institutionTeesside University; Health and Social Care Institute; Middlesbrough UKen
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
dc.contributor.institutionRadboud University Medical Center; Radboud Institute for Health Sciences, IQ Healthcare; Nijmegen the Netherlandsen
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