IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Addiction. 2012 Sep;107(9):1601-11. doi: 10.1111/j.1360-0443.2012.03868.x. Epub 2012 May 8.
To assess the effect of a tailored multi-faceted improvement programme on general practitioners' (GPs') behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organization and patient. Educational training sessions and visits by a facilitator were tailored to the GPs' needs and attitudes.
Cluster randomized controlled trial.
General practices in the Netherlands.
Seventy-seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed.
The primary outcome was the number of eligible patients who received screening and advice.
Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice-giving) at 12-month follow-up (not significant).
A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.
评估针对初级保健医生（GP）预防危险和有害饮酒行为的定制多方面改进计划对其行为的影响。该改进计划包括针对 GP、组织和患者的活动。教育培训课程和促进者的访问根据 GP 的需求和态度进行定制。
整群随机对照试验。
荷兰的一般实践。
77 家一般实践；119 名 GP 参与。共有 6318 名患者的数据可用，其中 765 名（12.1%）存在风险。总共审查了 1502 名患者的电子病历。
主要结果是接受筛查和建议的合格患者人数。
招募 GP 和激励 GP 参与计划的定制部分存在困难，这阻碍了计划的最佳实施。尽管两组 GP 在入组后都变得更加投入，但这种改善在试验过程中逐渐减弱。质量改进计划增强了最初的行为改善，并且与我们的对照条件相比，减轻了这种改善的减弱（干预组），导致 12 个月随访时的平均改善率为 5%（筛查）和 2%（建议）（不显著）。
旨在改善初级保健医生管理患者饮酒行为的定制、多方面计划未能显示出效果，并且实施起来很困难。几乎没有证据支持使用这种密集实施计划来改善初级保健中有害和危险饮酒的管理。
