Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C.

INTRODUCTION AND OBJECTIVE: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. METHOD: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. RESULTS: Thirty-two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR = 0.56; 95% CI, 0.31-0.99; P < .05). CONCLUSION: Although the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.

Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

BACKGROUND: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. METHODS: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. RESULTS: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro- level such as societal and political culture the effects risks to get nullified. CONCLUSIONS: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested. TRIAL REGISTRATION: ClinicalTrials.gov. Trial identifier: NCT01501552 .

Gender and family differences in adolescent's heavy alcohol use: the power-control theory perspective.

According to the power-control theory, growing independence of adolescent girls, manifest in more prevalent problem behaviors, may be explained by changes in family structure (increasing level of authority gained in the workplace by mothers). To verify this hypothesis, self-report data from Warsaw adolescents (N = 3087, age 14-15 years, 50% boys) were used. Results indicate that parenting practices differ across child gender and structure of parents' work authority. Girls, especially in patriarchal households, spend more time with mothers and perceive stronger maternal control. In egalitarian families, fathers tend to be more involved with sons than with daughters. When parental control, support and adolescents' risk preferences are controlled, the gender-by-household type interaction effect is observed--girls in patriarchal families have the lowest risk of getting drunk. Study results provide support for power-control theory showing the relationship between parental work authority and adolescent's heavy alcohol use.

[Elaboration and evaluation of mental health promotion programmes exemplified by a primary prevention alcohol programme]. / Opracowywanie i ewaluacja programów promocji zdrowia psychicznego na przykladzie programu wczesnej profilaktyki alkoholowej.

The article's aim is a presentation of the process a/elaboration and evaluation of the designed mental health prevention programmes. Keeping the logic of this process (from overall goal setting to outcome assessment) increases the chance that resources for preventive and research activities will be used in the most favourable way. The process starting point is the establishment of the general goal of the programme. At this stage the clarification how the term "mental health promotion" and prevention activities are understood is crucial. The definition choice determines the area of activity and points out the target group. It is important to base the programme on solid theoretical and empirical evidence. This implies the necessity of collecting data from various fields, e.g. mental health, developmental, educational and cognitive psychology as well as epidemiological and evaluation studies. All gathered information will permit the formulation of more operational programme goals, which will lead the authors to choose prevention topics and methods. It is also easy to convert the operational goals to evaluation questions related to the key elements of the programme. In turn, evaluation questions allow the creation of evaluation indicators. The following step is the selection of measurement methods and evaluation strategy. The process description is illustrated by the example of primary prevention alcohol programme "Program Domowych Detektywow" which is the Polish adaptation of the US "Slick Tracy Home Team" programme (a part of the "Northland Project"). The problems and difficulties related to the various phases of the process of programme development are discussed. The problems with evaluation planning and finding a compromise between methodological standards and real life conditions are underlined.