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Romero-Rodríguez E, Pérula de Torres LÁ, Fernández García JÁ, Roldán Villalobos A, Ruiz Moral R, Parras Rejano JM. Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study. PATIENT EDUCATION AND COUNSELING 2019; 102:2060-2067. [PMID: 31178165 DOI: 10.1016/j.pec.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the impact of a training program targeted to Primary Care (PC) professionalson the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. METHODS A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p < 0.05). RESULTS PC providers' communication skills and attitudes showed significant improvements in the variables studied (p < 0.001), as well as in the clinical interview evaluation parameters. CONCLUSION The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. PRACTICE IMPLICATIONS Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
| | - Luis Ángel Pérula de Torres
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Program of Preventive Activities and Health Promotion -PAPPS- (semFYC). Barcelona, Spain
| | - José Ángel Fernández García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villarrubia Health Center, Andalusian Health Service, Cordoba, Spain
| | - Ana Roldán Villalobos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Carlos Castilla Del Pino Health Center, Andalusian Health Service, Cordoba, Spain
| | - Roger Ruiz Moral
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Francisco de Vitoria University, Madrid, Spain
| | - Juan Manuel Parras Rejano
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villanueva del Rey Health Center, Andalusian Health Service, Cordoba, Spain
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Abstract
BACKGROUND Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized despite multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery. OBJECTIVES To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between the initiator (patient vs provider) and drinking after a BI. METHODS In the context of clinical trial, patients (n = 267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months after the BI. RESULTS Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 years vs 47.1 years; P = 0.03), more likely to meet Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for current major depression (24% vs 14%; P = 0.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs 52%; P < 0.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the 2 to 3 weeks after BI, self-initiators reported greater decreases in drinks per week (5.7 vs 2.4; P = 0.02), and drinking days per week (1.0 vs 0.3; P = 0.002). At 6-month follow-up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (P = 0.002). CONCLUSIONS Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.
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Nadkarni A, Hanlon C, Bhatia U, Fuhr D, Ragoni C, de Azevedo Perocco SL, Fortes S, Shidhaye R, Kinyanda E, Rangaswamy T, Patel V. The management of adult psychiatric emergencies in low-income and middle-income countries: a systematic review. Lancet Psychiatry 2015; 2:540-7. [PMID: 26360450 DOI: 10.1016/s2215-0366(15)00094-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/14/2015] [Accepted: 02/19/2015] [Indexed: 11/25/2022]
Abstract
The aim of this Review is to identify effective interventions and treatment guidelines to manage common types of psychiatric emergencies in non-specialist settings in low-income and middle-income countries. Mental health specialist services in low-income and middle-income countries are scarce. We did a systematic review of interventions for psychiatric emergencies and a literature search for low-income and middle-income-specific treatment guidelines for psychiatric emergencies. A dearth of high-quality guidelines and contextualised primary evidence for management of psychiatric emergencies in low-income and middle-income countries exists. Filling these gaps in present guidelines needs to be an urgent research priority in view of the adverse health and social consequences of such presentations and the present drive to scale up mental health care.
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Affiliation(s)
- Abhijit Nadkarni
- London School of Hygiene & Tropical Medicine, London, UK; Sangath, Porvorim, Goa, India
| | - Charlotte Hanlon
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Urvita Bhatia
- London School of Hygiene & Tropical Medicine, London, UK; Sangath, Porvorim, Goa, India
| | - Daniela Fuhr
- London School of Hygiene & Tropical Medicine, London, UK
| | - Celina Ragoni
- Social Medicine Institute, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sandra Fortes
- Medical Sciences School, University of Rio de Janeiro State, Brazil
| | - Rahul Shidhaye
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | | | | | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Sangath, Porvorim, Goa, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
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Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, Blackberry I, Borland R. Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC FAMILY PRACTICE 2010; 11:59. [PMID: 20701812 PMCID: PMC2931485 DOI: 10.1186/1471-2296-11-59] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/12/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients. METHODS/DESIGN This study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study and the process of written referral and GPs in the usual care group will receive information about the study. Eligible patients are those aged 18 and over presenting to their GP who are daily or weekly smokers and who are able to give informed consent. Patients on low incomes in all three groups will be able to access free nicotine patches.Primary outcomes are sustained abstinence and point prevalence abstinence at the three month and 12 month follow-up points; and incremental cost effectiveness ratios at 12 months. Process evaluation on the reach and acceptability of the intervention approached will be collected through Computer Assisted Telephone Interviews (CATI) with patients and semi-structured interviews with PNs and GPs.The primary analysis will be by intention to treat. Cessation outcomes will be compared between the three arms at three months and 12 month follow-up using multiple logistic regression. The incremental cost effectiveness ratios will be estimated for the 12 month quit rate for the intervention groups compared to usual care and to each other. Analysis of qualitative data on process outcomes will be based on thematic analysis. DISCUSSION High quality evidence on effectiveness of practice nurse interventions is needed to inform health policy on development of practice nurse roles. If effective, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice. TRIAL REGISTRATION ACTRN12609001040257.
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Affiliation(s)
- Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052 Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052 Australia
| | - Elizabeth Halcomb
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC Sydney NSW 1797, Australia
| | - John Furler
- Primary Care Research Unit, Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Melbourne Victoria 3053, Australia
| | - Julie Smith
- Australian Centre for Economic Research on Health, Australian National University Canberra, ACT 0200, Australia
| | - Oshana Hermiz
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Irene Blackberry
- Primary Care Research Unit, Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Melbourne Victoria 3053, Australia
| | - Ron Borland
- Cancer Council Victoria 1 Rathdowne St, Carlton, Melbourne Vic, 3053, Australia
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Clifford A, Pulver LJ, Richmond R, Shakeshaft A, Ivers R. Brief intervention resource kits for Indigenous Australians: generally evidence-based, but missing important components. Aust N Z J Public Health 2010; 34 Suppl 1:S80-6. [DOI: 10.1111/j.1753-6405.2010.00559.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Seale JP, Shellenberger S, Velasquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening & clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC FAMILY PRACTICE 2010; 11:18. [PMID: 20205740 PMCID: PMC2844356 DOI: 10.1186/1471-2296-11-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 03/05/2010] [Indexed: 11/13/2022]
Abstract
Background Though screening and intervention for alcohol and tobacco misuse are effective, primary care screening and intervention rates remain low. Previous studies have increased intervention rates using vital signs screening for tobacco misuse and clinician prompts for screen-positive patients for both alcohol and tobacco misuse. This pilot study's aims were: (1) To determine the feasibility of combined vital signs screening for tobacco and alcohol misuse, (2) To assess the impact of vital signs screening on alcohol and tobacco screening and intervention rates, and (3) To assess the additional impact of tobacco assessment prompts on intervention rates. Methods In five outpatient practices, nurses measuring vital signs were trained to routinely ask a single tobacco question, a prescreening question that identified current drinkers, and the single alcohol screening question for current drinkers. After 4-8 weeks, clinicians were trained in tobacco intervention and nurses were trained to give tobacco abusers a tobacco questionnaire which also served as a clinician intervention prompt. Screening and intervention rates were measured using patient exit interviews (n = 622) at baseline, during the "screening only" period, and during the tobacco prompting phase. Changes in screening and intervention rates were compared using chi square analyses and test of linear trends. Clinic staff were interviewed regarding patient and staff acceptability. Logistic regression was used to evaluate the impact of nurse screening on clinician intervention, the impact of alcohol intervention on concurrent tobacco intervention, and the impact of tobacco intervention on concurrent alcohol intervention. Results Alcohol and tobacco screening rates and alcohol intervention rates increased after implementing vital signs screening (p < .05). During the tobacco prompting phase, clinician intervention rates increased significantly for both alcohol (12.4%, p < .001) and tobacco (47.4%, p = .042). Screening by nurses was associated with clinician advice to reduce alcohol use (OR 13.1; 95% CI 6.2-27.6) and tobacco use (OR 2.6; 95% CI 1.3-5.2). Acceptability was high with nurses and patients. Conclusions Vital signs screening can be incorporated in primary care and increases alcohol screening and intervention rates. Tobacco assessment prompts increase both alcohol and tobacco interventions. These simple interventions show promise for dissemination in primary care settings.
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Affiliation(s)
- J Paul Seale
- Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, 3780 Eisenhower Pkwy, Macon, GA 31206, USA.
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Clifford A, Jackson Pulver L, Richmond R, Shakeshaft A, Ivers R. Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps. Health Promot Int 2009; 24:404-15. [PMID: 19887577 DOI: 10.1093/heapro/dap039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Indigenous Australians experience a disproportionately greater burden of harm from smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) than the general Australian population. A critical step in further improving efforts to reduce this harm is to review existing efforts aimed at increasing the uptake of evidence-based interventions in Indigenous-specific health-care settings and programs. This study systematically identifies and reviews published Indigenous-specific dissemination studies targeting SNAP interventions. An electronic search of eight databases and a manual search of reference lists of previous literature reviews were undertaken. Eleven dissemination studies were identified for review: six for nutrition and physical activity as a component of diabetes care, three for alcohol and two for smoking. The majority of studies employed continuing medical education (n = 9 studies), suggesting that improving health-care providers' knowledge and skills is a focus of current efforts to disseminate best-evidence SNAP interventions in Indigenous health-care settings. Only two studies evaluated reminder systems, despite their widespread use in Indigenous-specific health-care services, and only one study employed academic detailing, despite its cost-effectiveness at modifying health-care provider behavior. There is a clear need for more Indigenous-specific dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measures of Indigenous-specific health-care delivery, in order to determine which dissemination strategies are most likely to be effective in Indigenous health-care settings and programs.
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Affiliation(s)
- A Clifford
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW, Sydney, Australia.
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Benthem GHH, Heg RR, van Leeuwen YD, Metsemakers JFM. Teaching psychiatric diagnostics to general practitioners: Educational methods and their perceived efficacy. MEDICAL TEACHER 2009; 31:e279-e286. [PMID: 19811135 DOI: 10.1080/01421590802656008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Psychiatric disorders are hard to detect in a primary care setting. The vocational training for general practitioners (GPs) of the University of Maastricht, the Netherlands, intends to create a new comprehensive programme on diagnosing psychiatric disorders. AIM We consulted the literature to obtain an answer to the question: is evidence available for the effectiveness of specific educational methods to teach GP trainees psychiatric diagnostic skills? METHODOLOGY We searched in four databases for studies on a variety of search terms (39) referring to primary care, psychiatry, diagnosis, education and quality. As selection criterium for outcome measure we took change in diagnostic competence. RESULTS From a number of 769 articles 27 methodologically sound studies remained. This article presents several of their research characteristics. No conclusive evidence has been found for the effectivity of an isolated educational method. The combination of methods seems promising. However, no specific mix of methods is a guarantee for success. CONCLUSIONS We made some recommendations for training psychiatric diagnostic competency. The literature endorses our own idea that education in this field should include reflection on attitude and barriers.
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Shakeshaft A, Fawcett J, Mattick RP, Richmond R, Wodak A, Harris MF, Doran CM. Patient‐driven computers in primary care: their use and feasibility. HEALTH EDUCATION 2006. [DOI: 10.1108/09654280610686612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this research is to explore the feasibility of using patient‐driven, hand‐held computers in primary care settings, in order to address the apparent failure to implement prevention initiatives into the routine delivery of health care services.Design/methodology/approachDuring an eight‐day period, patients of an English primary care practice who were at least 16 years of age were asked to complete a health‐related survey using a hand‐held computer. They received tailored, on‐screen feedback.FindingsA total of 143 patients (approximately 55 per cent of all patients) began using a hand‐held computer, of whom 115 (80 per cent) answered all questions. Of these, 24 per cent reported being smokers, 7 per cent and 19 per cent were at‐risk of alcohol harm in the long and short term respectively and 14 per cent rated their overall health as poor or very poor. Most patients rated their level of satisfaction with the hand‐helds as excellent (36 per cent), very good (29 per cent) or good (24 per cent), while 89 per cent agreed to their primary care physician seeing a summary of their feedback.Originality/valueThis is the first study to evaluate the feasibility of using hand‐held computers to conduct patient screening and feedback in primary care settings.
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Nilsen P, Aalto M, Bendtsen P, Seppä K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care 2006; 24:5-15. [PMID: 16464809 DOI: 10.1080/02813430500475282] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To review systematically the available literature on implementation of brief alcohol interventions in primary healthcare in order to determine the effectiveness of the implementation efforts by the health are providers. KEY QUESTION: To what extent have the efforts to implement brief alcohol interventions in primary healthcare environments been successful? METHOD Literature search from Medline, Cinahl, PsychLIT, Cochrane. SETTING Primary healthcare. MATERIAL A total of 11 studies encompassing 921 GPs, 266 nurses, 88 medical students, and 44 "non-physicians" from Europe, the USA, and Australia. MAIN OUTCOME MEASURES Material utilization, screening, and brief intervention rates. ANSWER Intervention effectiveness (material utilization, screening, and brief intervention rates) generally increased with the intensity of the intervention effort, i.e. the amount of training and/or support provided. Nevertheless, the overall effectiveness was rather modest. However, the studies examined were too heterogeneous, not scientifically rigorous enough, and applied too brief follow-up times to provide conclusive answers.
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Affiliation(s)
- Per Nilsen
- Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, Sweden
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Seale JP, Shellenberger S, Boltri JM, Okosun IS, Barton B. Effects of screening and brief intervention training on resident and faculty alcohol intervention behaviours: a pre- post-intervention assessment. BMC FAMILY PRACTICE 2005; 6:46. [PMID: 16271146 PMCID: PMC1310533 DOI: 10.1186/1471-2296-6-46] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 11/04/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many hazardous and harmful drinkers do not receive clinician advice to reduce their drinking. Previous studies suggest under-detection and clinician reluctance to intervene despite awareness of problem drinking (PD). The Healthy Habits Project previously reported chart review data documenting increased screening and intervention with hazardous and harmful drinkers after training clinicians and implementing routine screening. This report describes the impact of the Healthy Habits training program on clinicians' rates of identification of PD, level of certainty in identifying PD and the proportion of patients given advice to reduce alcohol use, based on self-report data using clinician exit questionnaires. METHODS 28 residents and 10 faculty in a family medicine residency clinic completed four cycles of clinician exit interview questionnaires before and after screening and intervention training. Rates of identifying PD, level of diagnostic certainty, and frequency of advice to reduce drinking were compared across intervention status (pre vs. post). Findings were compared with rates of PD and advice to reduce drinking documented on chart review. RESULTS 1,052 clinician exit questionnaires were collected. There were no significant differences in rates of PD identified before and after intervention (9.8% vs. 7.4%, p = .308). Faculty demonstrated greater certainty in PD diagnoses than residents (p = .028) and gave more advice to reduce drinking (p = .042) throughout the program. Faculty and residents reported higher levels of diagnostic certainty after training (p = .039 and .030, respectively). After training, residents showed greater increases than faculty in the percentage of patients given advice to reduce drinking (p = .038), and patients felt to be problem drinkers were significantly more likely to receive advice to reduce drinking by all clinicians (50% vs. 75%, p = .047). The number of patients receiving advice to reduce drinking after program implementation exceeded the number of patients felt to be problem drinkers. Recognition rates of PD were four to eight times higher than rates documented on chart review (p = .028). CONCLUSION This program resulted in greater clinician certainty in diagnosing PD and increases in the number of patients with PD who received advice to reduce drinking. Future programs should include booster training sessions and emphasize documentation of PD and brief intervention.
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Affiliation(s)
- J Paul Seale
- Department of Family Medicine, Mercer University School of Medicine and Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon GA 31210, USA
| | - Sylvia Shellenberger
- Department of Family Medicine, Mercer University School of Medicine and Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon GA 31210, USA
| | - John M Boltri
- Department of Family Medicine, Mercer University School of Medicine and Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon GA 31210, USA
| | - IS Okosun
- Institute of Public Health, Georgia State University, One Park Place South, Sixth Floor, Suite 660, Atlanta, GA 30302, USA
| | - Barbara Barton
- Department of Family Medicine, Mercer University School of Medicine and Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon GA 31210, USA
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Barry KL, Blow FC, Willenbring ML, McCormick R, Brockmann LM, Visnic S. Use of Alcohol Screening and Brief Interventions<br />in Primary Care Settings:Implementation and Barriers. Subst Abus 2005; 25:27-36. [PMID: 15201109 DOI: 10.1300/j465v25n01_05] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although evidence indicates that brief alcohol screening and interventions are effective across primary care settings, implementation of these techniques has been problematic. The primary objective of this study was to determine current practices and barriers for screening and interventions with primary care patients across randomly selected clinics in a large health care system, the Veterans Health Administration. Focus groups and mailed structured surveys were used. Results from providers indicated that 85% of patients treated in primary care received some screening for alcohol use disorders. The CAGE was the predominant screening tool. The primary clinical focus was on treatment referrals for patients who met abuse/dependence criteria. Lack of time was the most important perceived barrier to implementing screening and brief alcohol interventions for at-risk and problem drinkers. Implications for implementation of screening and intervention programs for a range of drinkers (at-risk use, problem use, abuse, dependence) are discussed.
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Affiliation(s)
- Kristen L Barry
- University of Michigan Department of Psychiatry, 400 East Eisenhower Pkwy, Suite 2A, Ann Arbor, MI 48108, USA.
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Abstract
Parallels and contrasts between tobacco smoking and alcohol drinking are considered, in terms of harms, cultural positioning, and a dependence, which is social as well as physical and psychological. Evidence is briefly reviewed of two kinds of conjunction: of being a smoker and being a drinker, and of the smoking event and the drinking event. The complementary relation between smoking and drinking, it is argued, can be understood at physiological, psychological and social levels. Implications for prevention, intervention and policy are discussed, including the need for international agreement on alcohol as well as tobacco control.
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Affiliation(s)
- Robin Room
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Sveaplan, 106 91 Stockholm, Sweden.
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Kahan M, Wilson L, Midmer D, Borsoi D, Martin D. Randomized controlled trial on the effects of a skills-based workshop on medical students' management of problem drinking and alcohol dependence. Subst Abus 2003; 24:5-16. [PMID: 12652091 DOI: 10.1080/08897070309511529] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether a skills-based workshop will improve medical students' management of problem drinking and alcohol dependence in simulated patients. Seventy-six 3rd and 4th year Ontario medical students were randomized to receive a 3-h workshop on either problem drinking and alcohol dependence or depression (control condition). Students then completed eight simulated office visits (OSCE stations) with simulated patients presenting with depression, problem drinking or alcohol dependence. Examiners completed a checklist of the questions asked and advice given by the student, and simulated patients and examiners completed a global rating scale. Four months later, students were sent a survey on their knowledge, attitudes, and behavior towards patients with alcohol problems. The alcohol group received significantly higher assessment and management checklist scores and global rating scores than did the depression group (p < 0.01) and performed better on almost all aspects of clinical management of both problem drinking and alcohol dependence. On the follow-up survey (n = 55) the alcohol group showed a significant increase in beliefs about self-efficacy in managing alcohol problems (p < 0.05) and had greater knowledge of reduced drinking strategies, but the two groups did not differ on other measures. A skills-based workshop causes marked short-term improvements in medical students' management of problem drinking and alcohol dependence, an increase from baseline to postworkshop in self-efficacy beliefs that was sustained through to follow-up, and greater knowledge of reduced drinking strategies. Repeated reinforcement of clinical skills may be required for a long-term impact on clinical behavior.
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Affiliation(s)
- Meldon Kahan
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
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Brady M, Sibthorpe B, Bailie R, Ball S, Sumnerdodd P. The feasibility and acceptability of introducing brief intervention for alcohol misuse in an urban aboriginal medical service. Drug Alcohol Rev 2002; 21:375-80. [PMID: 12537708 DOI: 10.1080/0959523021000023243] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report on the feasibility and perceived acceptability of brief motivational interviewing for hazardous alcohol use in an urban Aboriginal health service. General practitioners (GPs) were trained in brief motivational interviewing, and health workers in other aspects of the intervention. Screening was initially carried out using the AUDIT, but subsequently reduced to two simple questions. Information was obtained through a combination of participant observation by the study team, ongoing ad hoc review and feedback from staff, periodic group meetings, and one-on-one interviews with health workers and GPs. The AUDIT was felt to be intrusive and some questions were poorly understood. Brief intervention seemed to be culturally appropriate, but barriers to wider administration included lack of time and the complexity of patients' presenting health problems. As a result of the research there was an increase in general awareness and acceptability of addressing alcohol issues at the health service. This study raises a number of issues that both support and threaten the wide implementation of brief intervention in urban Aboriginal primary care settings.
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Affiliation(s)
- Maggie Brady
- Centre for Aboriginal Economic Policy Research, Australian National University, Canberra ACT, Australia
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Roche AM, Hotham ED, Richmond RL. The general practitioner's role in AOD issues: overcoming individual, professional and systemic barriers. Drug Alcohol Rev 2002; 21:223-30. [PMID: 12270072 DOI: 10.1080/0959523021000002679] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
General practitioners (GPs) and increasingly other medical practitioners are well placed to address alcohol and other drug (AOD) problems. Their involvement in this area of care, however, is assessed to be less than optimal. There is, however, a growing body of evidence for the potential efficacy of medical practitioner intervention at the primary care, emergency department and in-patient level. There is also considerably expanded scope to operate from an evidence-based perspective. However, key questions arise regarding what constitutes best practice in the translation of the growing AOD knowledge base into clinical practice behaviours. This paper explores possible contributory factors to the low level of engagement with AOD issues by GPs and examines a wide range of individual, structural and systemic issues that may be amenable to change. Strategies for the dissemination of research findings, changing professional practice behaviour and introducing sustainable structural reforms are also addressed.
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Affiliation(s)
- Ann M Roche
- National Centre for Education and Training on Addiction (NCETA), Flinders University of South Australia, Australia
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Barry KL, Blow FC, Oslin DW. Substance abuse in older adults: Review and recommendations for education and practice in medical settings. Subst Abus 2002; 23:105-31. [DOI: 10.1080/08897070209511510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sibthorpe BM, Bailie RS, Brady MA, Ball SA, Sumner-Dodd P, Hall WD. The demise of a planned randomised controlled trial in an urban Aboriginal medical service. Med J Aust 2002; 176:273-6. [PMID: 11999260 DOI: 10.5694/j.1326-5377.2002.tb04406.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2001] [Accepted: 12/12/2001] [Indexed: 11/17/2022]
Abstract
To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part "demonstration project". Only 16 clients were recruited for follow-up in six-months, and the trial was terminated. Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and "gold-standard" RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.
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Affiliation(s)
- Beverly M Sibthorpe
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.
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Watson H. The Nursing Council on Alcohol. DRUGS AND ALCOHOL TODAY 2001. [DOI: 10.1108/17459265200100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Blow FC, Barry KL. Older patients with at-risk and problem drinking patterns: new developments in brief interventions. J Geriatr Psychiatry Neurol 2001; 13:115-23. [PMID: 11001133 DOI: 10.1177/089198870001300304] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between alcohol and some of the most prevalent physical and mental health issues of older adulthood and the fact that a large percentage (up to 60% in randomized clinical trials) of older at-risk drinkers may need either more intense or innovative approaches to help them cut down or stop drinking have led to new developments in alcohol screening and brief interventions with older adults. Technological and content innovations are critical elements in providing rapid, effective interventions with a spectrum of alcohol use problems in later adulthood. Both primary and specialty care providers can be trained to provide motivational brief alcohol interventions targeted to the older patient. Novel approaches to screening, brief interventions, and brief therapies can be combined with the use of new technologies to facilitate implementation in a range of health care settings. This will give mental health specialty providers additional strategies for addressing the complex needs of older at-risk drinkers using a family of efficient and effective approaches.
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Affiliation(s)
- F C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Laforge RG, Velicer WF, Richmond RL, Owen N. Stage distributions for five health behaviors in the United States and Australia. Prev Med 1999; 28:61-74. [PMID: 9973589 DOI: 10.1006/pmed.1998.0384] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A key variable for the design of individual and public health interventions is the Stage of Change. The five stages of readiness to change are Precontemplation, Contemplation, Preparation, Action, and Maintenance. The distribution of individuals across the stages of change can provide a valuable tool for designing health interventions. METHODS The pattern of distribution across the stages of change for five behavioral risk factors is presented from five independent surveys, two from the United States and three from Australia. The five risk factors are smoking, low fat diet, regular exercise, reducing stress, and losing weight. Identical single-item questionnaire items for staging health behaviors were used in all surveys. RESULTS The stage distributions for the five risk factors were similar across the five independent samples. In general, the pattern of stage distributions was stable across health risk factors, gender, country, and sample. CONCLUSIONS Single-item survey measures of stage of change that are readily applicable to population studies appear to provide important information about the population characteristics of readiness to change behavioral risk factors. The stability of these distributions suggests that interventions matched by stage may have broad applicability.
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Affiliation(s)
- R G Laforge
- Cancer Prevention Research Center University of Rhode Island, Kingston 02881, USA.
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