Hyland Karin, Hammarberg Anders, Hedman-Lagerlöf Erik, Wiklund Olle, Rosendahl Ingvar, Andreasson Sven, Nilsen Per
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
Eur J Public Health. 2025 Aug 1;35(4):720-725. doi: 10.1093/eurpub/ckaf060.
The present study aimed to investigate the extent to which two new implementation strategies-a new policy mandating alcohol interventions in primary care and access to online training, impacted alcohol-related clinical activities in primary care in Stockholm. This was a prospective longitudinal register-based study. One hundred twenty-nine primary care clinics in Region Stockholm agreed to provide data. The new healthcare policy was introduced in February 2021. A brief digital training for primary care professionals on managing harmful alcohol use and dependence was launched 10 months later. Seven indicators that reflect alcohol-related clinical activities were obtained from electronic case files: structured documentation on alcohol habits, the AUDIT instrument, ordering of blood tests for biomarkers of heavy drinking, prescription of medicines for alcohol dependence, registered alcohol-related diagnoses, completed advice regarding alcohol use disorder (AUD), and referrals to specialized care. Data from registers were collected before and after the policy and training was available. At baseline low levels of alcohol-related clinical activities were found in primary care. A modest, clinically non-significant increase was seen for all indicators except for frequency of prescription of medicines for alcohol dependence, over the whole follow-up. The digital training was not associated with an increase in alcohol-related clinical activities. While a policy making alcohol interventions mandatory, combined with a training program, has strong support from implementation science, only a modest, clinically non-significant increase in alcohol-related clinical activities was found. Stronger implementation strategies seem necessary to improve management of alcohol dependence in primary care.
本研究旨在调查两种新的实施策略——一项在初级保健中强制进行酒精干预的新政策和在线培训的获取途径，对斯德哥尔摩初级保健中与酒精相关的临床活动产生的影响程度。这是一项基于登记册的前瞻性纵向研究。斯德哥尔摩地区的129家初级保健诊所同意提供数据。新的医疗政策于2021年2月出台。10个月后，针对初级保健专业人员开展了关于管理有害酒精使用和依赖的简短数字培训。从电子病例档案中获取了七个反映与酒精相关临床活动的指标：关于饮酒习惯的结构化记录、酒精使用障碍识别测试（AUDIT）工具、为重度饮酒生物标志物进行血液检测的医嘱、酒精依赖药物处方、登记的与酒精相关的诊断、关于酒精使用障碍（AUD）的完整建议以及转介至专科护理。在政策和培训实施前后收集登记册数据。在基线时，初级保健中与酒精相关的临床活动水平较低。在整个随访期间，除酒精依赖药物处方频率外，所有指标均出现了适度的、临床无显著意义的增加。数字培训与与酒精相关的临床活动增加无关。虽然一项强制进行酒精干预并结合培训计划的政策在实施科学方面得到了有力支持，但仅发现与酒精相关的临床活动有适度的、临床无显著意义的增加。似乎需要更强有力的实施策略来改善初级保健中酒精依赖的管理。
