Historique
Article de Périodique
Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme (2012)
Auteur(s) :
I. VAN BEURDEN ;
P. ANDERSON ;
R. P. AKKERMANS ;
R. P. T. M. GROL ;
M. WENSING ;
M. G. H. LAURANT
Article en page(s) :
1601-1611
Refs biblio. :
58
Domaine :
Alcool / Alcohol
Langue(s) :
Anglais
Thésaurus géographique
PAYS-BAS
Thésaurus mots-clés
ALCOOL
;
MEDECIN GENERALISTE
;
PRISE EN CHARGE
;
ETUDE RANDOMISEE
;
INTERVENTION BREVE
;
PROGRAMME
Résumé :
Aims: To assess the effect of a tailored multi-faceted improvement programme on general practitioners' (GPs') behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organization and patient. Educational training sessions and visits by a facilitator were tailored to the GPs' needs and attitudes.
Design: Cluster randomized controlled trial.
Setting: General practices in the Netherlands.
Participants: Seventy-seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed.
Measurements: The primary outcome was the number of eligible patients who received screening and advice.
Findings: Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice-giving) at 12-month follow-up (not significant).
Conclusions: A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.
KEY FINDINGS:
Tailored, multi-faceted programmes aimed at improving general practitioners' management of patients' drinking are difficult to implement and do not show an effect on practitioners' rates of screening or advising their patients on alcohol use.
Design: Cluster randomized controlled trial.
Setting: General practices in the Netherlands.
Participants: Seventy-seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed.
Measurements: The primary outcome was the number of eligible patients who received screening and advice.
Findings: Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice-giving) at 12-month follow-up (not significant).
Conclusions: A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.
KEY FINDINGS:
Tailored, multi-faceted programmes aimed at improving general practitioners' management of patients' drinking are difficult to implement and do not show an effect on practitioners' rates of screening or advising their patients on alcohol use.
Affiliation :
IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands