Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C

INTRODUCTION AND OBJECTIVE

The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper.

METHOD

From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling.

RESULTS

Thirty-two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR = 0.56; 95% CI, 0.31-0.99; P < .05).

CONCLUSION

Although the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.

Healthy diet in primary care: views of general practitioners and nurses from Europe

BACKGROUND

Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices.

OBJECTIVE

To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses.

DESIGN

A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV.

RESULTS

The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned.

CONCLUSIONS

GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.

[Role of alcoholism in the development of upper gastrointestinal tumors]

A preliminary report on the results of studies on the relationship between alcohol abuse and upper gastrointestinal tumours is presented. Alcohol abuse was measured with the aid of a questionnaire. GGTP and mean MCV were determined. Within the 1st September, 1986--30th September, 1987, 75 patients with the cancer of the upper gastrointestinal tract and 107 patients with benign lesions to this area were examined. Alcohol abuse was found in 33% of patients with the cancer and 19% of patients with benign lesions to the upper gastrointestinal tract. This difference is statistically significant (p greater than 0.05). The results of GGTP and MCV values were statistically insignificant in both groups. The authors have found more marked correlation of alcohol abuse with the cancer of the upper gastrointestinal tract in relation to the oral cavity and pharynx than the stomach. Further studies including larger groups of patients are recommended.