Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study

Background Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption. Methods and findings A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 12% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels. Conclusions Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.

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Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study

PLoS ONE ◽

10.1371/journal.pone.0255843 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255843

Author(s):

Jakob Manthey ◽

Adriana Solovei ◽

Peter Anderson ◽

Sinclair Carr ◽

Jürgen Rehm

Keyword(s):

Health Care ◽

Primary Health Care ◽

Alcohol Consumption ◽

Alcohol Use ◽

Open Access ◽

Simulation Model ◽

Population Level ◽

Primary Health ◽

Screening Coverage ◽

Coverage Rates

Background Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption. Methods and findings A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 11% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels. Conclusions Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.

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Russian-language mobile applications for reducing alcohol use: a systematic search and evaluation. (Preprint)

10.2196/preprints.31058 ◽

2021 ◽

Author(s):

Anna Bunova ◽

Veronika Wiemker ◽

Boris Gornyi ◽

Carina Ferreira-Borges ◽

Maria Neufeld

Keyword(s):

Health Care ◽

Primary Health Care ◽

Alcohol Consumption ◽

Alcohol Use ◽

Mobile Applications ◽

Russian Language ◽

Brief Interventions ◽

Bibliographic Databases ◽

Lifestyle Behavior ◽

Primary Health

BACKGROUND Personalized prevention tools, such as mobile applications designed to reduce alcohol consumption, are widespread in mobile application stores accessible in Russia. However, their quality and content have not been systematically evaluated. OBJECTIVE This study aimed to identify Russian-language mobile applications for reducing alcohol use and evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify applications that could facilitate screening and brief interventions in primary health care in Russia. METHODS A systematic search for mobile applications available in Russia was carried out between April 1 and 15, December 1 and 15, 2020, and in March 2021 in the iOS App Store, Google Play Store, and the 4PDA forum. Application quality was assessed via the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases used to evaluate the applications’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). RESULTS We identified a total of 63 mobile applications for reducing alcohol use. Mean MARS quality ratings were high for the subscales of “Functionality” (3.92 out of 5, SD = 0.58) and “Aesthetics” (2.96; SD = 0.76) and low for “Engagement” (2.42; SD = 0.76) and “Information” (1.65, SD = 0.60). Additional searches in electronic libraries and bibliographic databases (Elibrary, Cyberleninka, Google Scholar) yielded no studies involving the identified applications. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD = 3.24). Two of the identified applications might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. CONCLUSIONS Russian-language mobile applications for reducing alcohol use are accessible in the application stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about scientific trialing or testing is lacking. Most applications contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile applications for reducing alcohol use. Our findings underline the need to develop evidence-based applications to mitigate alcohol consumption in Russia and elsewhere. CLINICALTRIAL PROSPERO (CRD42020167458) (review ongoing).

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Prevalence and pattern of alcohol consumption among males attending primary health care setting using AUDIT in rural Indore, Madhya Pradesh, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183994 ◽

2018 ◽

Vol 5 (10) ◽

pp. 4461 ◽

Cited By ~ 5

Author(s):

Jayashri Bute ◽

Sangeeta Kori ◽

V. K. Arora ◽

Aarti Sahasrabuddhe

Keyword(s):

Health Care ◽

Primary Health Care ◽

Family History ◽

Alcohol Consumption ◽

Alcohol Use ◽

Care Setting ◽

Positive Family History ◽

Low Risk ◽

Primary Health Care Setting ◽

Primary Health

Background: Alcohol consumption is one of the public health problems in India which acts as major attributable risk factor for majority of morbidity and mortality among adults. The objectives of the study were to find out the prevalence of alcohol consumption and its associated factors in rural area by using a WHO tool, AUDIT (Alcohol Use Disorder Identification Test) and to identify extent and pattern of alcohol consumption.Methods: This study was cross-sectional study. Three hundred sixty four male patients ≥15 years of age, attending OPD in a primary health care setting were interviewed by using a structured questionnaire and AUDIT.Results: The overall prevalence of ever consumed alcohol was found to be 49.7%; of which 38.2% were current drinkers and 11.5% were former drinkers while rest 50.3% were life time abstainers. Educational status, occupation, tobacco use and positive family history were significantly associated with alcohol consumption; while type and size of family, socioeconomic status were found insignificant association. About 53.9% preferred country-made liquor while 23.8% Indian Made Foreign Liquor (IMFL). Enjoyment (45.3%), relaxation or stress buster or social cause (29.5%), peer pressure (25.2%) being the reasons for alcohol consumption. In 33% of consumers, daily drinking and in 36% consumers, 1-5 times per week frequency for alcohol drinking was seen respectively. Three fourth of them purchased alcohol from local shops. Out of 364 subjects 75% belongs to AUDIT score of low risk, 11.2% with alcohol use in excess of low risk, 3.6% with harmful and hazardous drinking and 10.2% with dependent drinking.Conclusions: In our study, alcoholism is found to be more common among illiterates, non-formers, among tobacco users and those having positive family history. Socio economic status and age is not the bar for alcohol consumption.

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“We improved our life because I cut my drinking”: Qualitative analysis of a brief intervention for people with alcohol use disorder in Ethiopian primary health care

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2021.108636 ◽

2021 ◽

pp. 108636

Author(s):

Selamawit Zewdu ◽

Charlotte Hanlon ◽

Abebaw Fekadu ◽

Girmay Medhin ◽

Solomon Teferra

Keyword(s):

Health Care ◽

Primary Health Care ◽

Alcohol Use ◽

Qualitative Analysis ◽

Brief Intervention ◽

Alcohol Use Disorder ◽

Primary Health

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Medication and test prescription by nurses: contributions to advanced practice and transformation of care

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.2423-3062 ◽

2018 ◽

Vol 26 (0) ◽

Cited By ~ 2

Author(s):

Wezila Gonçalves do Nascimento ◽

Severina Alice da Costa Uchôa ◽

Ardigleusa Alves Coêlho ◽

Francisco de Sales Clementino ◽

Maria Valéria Beserra Cosme ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Open Access ◽

Nursing Care ◽

Institutional Support ◽

Advanced Practice ◽

Corporate Policies ◽

Primary Health

ABSTRACT Objective: To carry out a documentary study on the rules, guidelines, policies and institutional support for the nurse to prescribe medicines and request tests with a view to the advanced practice in the scope of Primary Health Care. Methods: Documentary research using open-access institutional documents - Federal Nursing Council (COFEN), its regional representations in the respective Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). Results: Most of the news/notices were issued by the Regional Nursing Councils in the different Federative Units. The argumentation regarding the prescription of medicines and request for tests by nurses is based on three categories: Autonomy and competencies for the prescription of medicines and/or request of tests; Corporate policies that undermine the full exercise of nursing; and Transformation of health and nursing care in Primary Health Care. Conclusion: The prescriptive practice by nurses integrates health care and has been defended by the institutions that represent the category. It emerges as an important element of advanced practice and in the transformation of care in the context of health teams.

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Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193630 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3630 ◽

Cited By ~ 1

Author(s):

Abbey Diaz ◽

Brenda Vo ◽

Peter D. Baade ◽

Veronica Matthews ◽

Barbara Nattabi ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Primary Health Care ◽

Torres Strait Islander ◽

Cervical Screening ◽

Service Level ◽

Factors Associated ◽

Primary Health ◽

Screening Coverage ◽

Torres Strait

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20–64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29–67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia’s public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.

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Problems Related to Alcohol Consumption in Primary Health Care: Prevalence and Clinical Profile

Family Practice ◽

10.1093/fampra/10.4.424 ◽

1993 ◽

Vol 10 (4) ◽

pp. 424-430 ◽

Cited By ~ 8

Author(s):

F ESCOBAR ◽

F ESPI ◽

M CANTERAS

Keyword(s):

Health Care ◽

Primary Health Care ◽

Alcohol Consumption ◽

Clinical Profile ◽

Primary Health

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High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa

International Journal of STD & AIDS ◽

10.1177/0956462416660016 ◽

2016 ◽

Vol 28 (7) ◽

pp. 651-659 ◽

Cited By ~ 6

Author(s):

Diana Huis in ‘t Veld ◽

Supa Pengpid ◽

Robert Colebunders ◽

Linda Skaal ◽

Karl Peltzer

Keyword(s):

South Africa ◽

Health Care ◽

Primary Health Care ◽

High Risk ◽

Alcohol Use ◽

Hiv Infection ◽

Psychosocial Factors ◽

Low Risk ◽

Health Care Clinics ◽

Primary Health

Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients’ medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients’ socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31–43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9–40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the ‘level of independence’-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.

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