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Wednesday, February 29, 2012

Involvement of general practitioners in managing alcohol problems: a randomised controlled trial of a tailored improvement programme.

To assess the effect of a tailored multi-facetted improvement programme on GPs' behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organisation and patient. Educational trainings and visits by a facilitator were tailored to the GPs’ needs and attitudes.

Cluster randomised controlled trial.

General practices in the Netherlands.

77 general practices, 119 GPs participated. Data from 6318 patients were available of whom 765 (12.1%) were at risk. 1502 patients’ electronic medical records were reviewed.

The primary outcome was the number of eligible patients who received screening and advice.

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 group became more involved after enrolment, this improvement faded during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered fading (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).

A tailored, multi-facetted programme aimed at improving GP 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 intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.

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