Alcohol and Alcoholism Advance Access originally published online on September 11, 2007
Alcohol and Alcoholism 2007 42(6):593-603; doi:10.1093/alcalc/agm063
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Screening and brief intervention targeting risky drinkers in danish general practice—A pragmatic controlled trial
1 Research Unit and Department for General Practice, Centre for Health and Community, University of Copenhagen
2 Medical Office of Health, City of Copenhagen, Denmark
* Author to whom correspondence should be addressed at: Research Unit and Department for General Practice, University of Copenhagen, Centre for Health and Community, Oster Farimagsgade 5, DK-1014 Copenhagen K, Denmark. Tel: +45 3532 7171; Fax: +45 3537 1282; E-mail: ab{at}gpract.ku.dk
Received 4 October 2006; first review notified 20 May 2007; ; accepted 18 July 2007
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Abstract |
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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.
The original version of this article contained numerous serious errors, for which the publisher sincerely apologises.