Screening and brief intervention targeting risky drinkers in danish general practice—A pragmatic controlled trial

• Published in: Alcohol and alcoholism (Oxford) Vol. 42; no. 6; pp. 593 - 603
• Main Authors: Beich, Anders, Gannik, Dorte, Saelan, Henrik, Thorsen, Thorkil
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2007; Oxford Publishing Limited (England)
• Subjects: Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Alcohol consumption; Alcohol Drinking - epidemiology; Alcohol Drinking - prevention & control; Alcoholism; Alcoholism - diagnosis; Alcoholism - epidemiology; Alcoholism - prevention & control; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Brief interventions; Denmark - epidemiology; Family Practice - methods; Female; Follow-Up Studies; Gender differences; General practice; Humans; Male; Mass Screening - methods; Medical sciences; Middle Aged; Physician's Role; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Screening; Toxicology; Denmark; Europe; Alcoholic beverage; Screening; Target; Treatment; Targeting; Alcoholism; Risk factor; Clinical trial; General practice; Medical screening; Pragmatics
• DOI: 10.1093/alcalc/agm063
• ISSN: 0735-0414; 1464-3502

Aims: Recommendations for routine alcohol screening and brief counselling intervention in primary health care rest on results from intervention efficacy studies. By conducting a pragmatic controlled trial (PCT), we aimed at evaluating the effectiveness of the WHO recommendations for screening and brief intervention (SBI) in general practice. Methods: A randomized PCT (brief counselling intervention vs no intervention) involving 39 Danish general practitioners (GPs). Systematic screening of 6897 adults led to inclusion of 906 risky drinkers, and research follow-up on 537 of these after 12–14 months. Outcome measures focused on patients' acceptance of screening and intervention and their self-reported alcohol consumption. Results: Patient acceptance of screening and intervention −10.3% (N = 794) of the target population (N = 7, 691) explicitly refused screening. All intervention group subjects (N = 442) were exposed to an instant brief counselling session while only 17.9% of them (79/442) attended a follow-up consultation that was offered by their GP. Consumption Changes At one-year follow-up, average weekly consumption had increased by 0.7 drinks in both comparison groups. As secondary findings, we observed an indiscriminate absolute risk reduction (ARR = 0.08 (95% CI: −0.02; 0.18)) in male binge drinking, but adverse intervention effects for women on the secondary outcomes (binge drinking ARR = −0.30 (95% CI: −0.47; −0.09)). Conclusions: The results of brief interventions in everyday general practice performed on the basis of systematic questionnaire screening may fall short of theoretical expectations. When applied to non-selected groups in everyday general practice SBI may have little effect and engender diverse outcome. Women may be more susceptible to defensive reactions than men.