Search

AimTo test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.DesignCluster randomized factorial trial with 12-week implementation and measurement period.SettingPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.ParticipantsA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.InterventionsPHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.MeasurementsThe primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period.FindingsDuring a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13–1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56–2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77–3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11–2.53).ConclusionsProviding primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.

Introduction Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a web-based BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI. Method and analysis A randomised controlled non-inferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis. Ethics and dissemination The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations. Trial registration number ClinicalTrials.gov NCT02082990.

Detailed description of applied implementation strategies. (PDF 971 kb)

Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners attitudes, their actual behaviour and care improvement strategies to enhance implementation science. Funding Agencies|European Union [259268]; Netherlands Organisation for Health Research and Development (ZonMW, Prevention Program) [200310017]; Polish science financial resources - project ODHIN [2304/7.PR-COOPERATION/11/2012/2]; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust; Kings College London; NIHR Collaborations for Leadership in Applied Health Research and Care South London at Kings College Hospital NHS Foundation Trust

RESUMEN: Introducción: El suelo pélvico es un complejo de estructuras musculares, fascias, vasos, nervios y orificios, que forman una unidad anatómica y funcional. Al estar situados en la parte inferior de la cavidad pélvica, estos músculos son antigravitatorios, por lo que deben ser óptimos para soportar la carga. A lo largo de la vida las mujeres son sometidas a numerosos factores de riesgo y por ellos el suelo pélvico puede debilitarse o ser herido. Sin ser un problema vital, estas disfunciones tienen un impacto negativo en el aspecto social, sexual, psicológico y laboral de estas mujeres. Es importante tener un buen conocimiento de él y realizar una correcta contracción de esta musculatura para poder abordar un trabajo de fisioterapia óptimo tanto a nivel preventivo como curativo. Objetivos: Estudiar el suelo pélvico en la mujer. El conocimiento de las mujeres nulíparas sobre el suelo pélvico y su capacidad de realizar una contracción de esta musculatura. Material y método: Se diseñó un estudio de carácter transversal con una muestra de 20 mujeres nulíparas, de edad comprendida entre los 20 y 35 años, las cuales respondieron una encuesta y posteriormente fueron sometidas a una breve exploración individual. Resultados: El análisis estadístico se realizó con el programa IBM SPSS Statistics 20. Se demuestran valores de p>0.05 en la comparación entre el conocimiento previo frente a la localización del SP y las contracciones parásitas frente a la fuerza muscular. De aquellas que decían tener conocimientos, estos fueron escasos y en algún aspecto erróneo y a pesar de que todas realizaron una contracción, la fuerza varió mucho de una a otra. Conclusiones: Existe un gran desconocimiento sobre la musculatura del suelo pélvico en las mujeres nulíparas sometidas a estudio y a pesar de que la capacidad de contracción de estas chicas es positiva, la fuerza contráctil varía en cada una de ellas. ABSTRACT: Introduction: The pelvic floor is a complex of structures of muscles, fascias, vessels, nerves and holes, which form an anatomical and functional unit. As they are located in the lower part of the pelvic cavity, these antigravity muscles must support the load. Throughout life, women are subjected to several risk factors and can weaken or hurt the pelvic floor. Without being a vital problem, these dysfunctions have a negative impact on the social, sexual and psychological aspect of these women. It is important to have a good knowledge of pelvic floor and to make a correct contraction of these muscles to reach and optimal work of physiotherapy both in a preventive and a curative level. Objectives: To study pelvic floor in women. The awareness of the pelvic floor in nulliparous women and their ability to make a muscle contraction. Material and methods: A cross-sectional study was performed on 20 nulliparous women between the ages of 20 and 35 years, who answered a survey and afterwards underwent a brief individual exploration. Results: The statistical analysis was realized by the program IBM SPSS Statistics 20. There is demonstrated that p> 0.05 values aren’t significant. The comparison was in the one hand between the previous knowledge opposite to the location of the pelvic floor and in the other hand the parasitic contractions opposite to the muscular force. Of those who said, they had a few and wrong knowledge, and despite all of them realized a contraction, although the force changed between these women. Conclusion: A great ignorance about the muscles on the pelvic floor exists in the nulliparous women submitted to the study and although the capacity of contraction of these girls is positive, the contractile force changes in each of them. Grado en Fisioterapia

Item does not contain fulltext AIMS: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. METHODS: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. RESULTS: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. CONCLUSION: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.