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Alcohol screening and brief intervention in primary care settings: implementation models and predictors
Thomas E Babor1, John Higgins-Biddle, Deborah Dauser
1The Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut 06030-6325, USA. babor@nso.uchc.edu
Journal of Studies on Alcohol
|July 29, 2005
Summary
The S Model, using nurses for alcohol screening and brief intervention (SBI), showed higher patient engagement than the P Model (doctors). Success depends on provider and organizational factors.
Area of Science:
- Public Health
- Healthcare Management
- Addiction Medicine
Background:
- Alcohol screening and brief intervention (SBI) is crucial for hazardous drinkers in primary care.
- The 'Cutting Back' program aimed to improve SBI implementation.
- Two models, P (physician-led) and S (nurse-led), were compared.
Purpose of the Study:
- To compare the effectiveness of two implementation strategies for the 'Cutting Back' SBI program.
- To identify organizational factors influencing SBI success.
Main Methods:
- 10 primary care practices in managed care organizations (MCOs) participated.
- Clinics were randomized to either the P Model (medical providers) or S Model (mid-level professionals/nurses).
- Data collected on screening and intervention delivery performance.
Main Results:
- The S Model achieved higher screening percentages (50% vs 44% peak; 24% vs 19% overall).
- More positive screens received intervention in the S Model (73.1% vs 57.1%).
- Clinic performance varied; success correlated with provider/organizational factors (experience, MCO stability, training, coordinator quality).
Conclusions:
- The optimal SBI delivery model (P or S) is contingent upon specific provider and organizational characteristics.
- Successful implementation requires addressing factors like provider time, staff turnover, and competing priorities.