• Peter Anderson, Karolina Kłoda, Eileen Kaner, Jillian Reynolds, Preben Bendtsen, Myrna N Pelgrum-Keurhorst, Lidia Segura, Marcin Wojnar, Artur Mierzecki, Paolo Deluca, Dorothy Newbury-Birch, Kathryn Parkinson, Katarzyna Okulicz-Kozaryn, Colin Drummond, LaurantMiranda G HMGHf Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare) , Nijmegen , the Netherlands.n Faculty of Health and Social Studies , HAN University of Applied Sc, and Antoni Gual.
• a Institute of Health and Society , Newcastle University , Newcastle , UK.
• Eur J Gen Pract. 2017 Dec 1; 23 (1): 241-245.

BackgroundThe implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training.ObjectivesUndertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline.MethodsA cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised.ResultsNurses tended to screen more patients than doctors (OR = 3.1; 95%CI: 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95%CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95%CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status.ConclusionsTraining primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.

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