Alcohol and Alcoholism Advance Access published online on September 11, 2007
Alcohol and Alcoholism, 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; in revised form 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.