Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs

Aims: To review the literature on detection of risky drinking to compare early identification based on everyday clinical encounters with systematic screening. We also reviewed specific clinical signs that have been suggested to be used as indicators of risky drinking. Methods: A literature review was performed in PubMed and CINAHL of articles up to November 2010. Results: Systematic screening and semi-systematic methods in various forms detected more risky drinkers than non-systematic identification during clinical encounter, but there was a lack of studies comparing the various means of identifying risky drinking. It may be too early to completely rule out the possibility of using non-systematic methods as an effective strategy to identify risky drinking. The earliest signs of risky drinking suggested in the literature are psychological distress and social problems. Conclusion: From a public health perspective, there is a lack of evidence that non-systematic or semi-systematic methods can substitute systematic screening in terms of numbers of risky drinkers detected. If early signs are going to be used to identify risky drinkers, or those to be screened for risky drinking, more focus should be on psychological and social signs because they appear earlier than somatic signs.This is a pre-copy-editing, author-produced PDF of an article accepted for publication in ALCOHOL AND ALCOHOLISM following peer review. The definitive publisher-authenticated version Hanna K Reinholdz, Preben Bendtsen and Fredrik Spak, Different Methods of Early Identification of Risky Drinking: A Review of Clinical Signs, 2011, ALCOHOL AND ALCOHOLISM, (46), 3, 283-291. is available online at: http://dx.doi.org/10.1093/alcalc/agr021 Copyright: Oxford University Press http://www.oxfordjournals.org

Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care

Background: Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention. Methods: Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving na\uefve understanding, structural analysis and comprehensive understanding. Results: Two major themes captured clinicians\u27 perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following one\u27s perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines. Conclusions: In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision- and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors

Impact of primary health care providers’ initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

Background: Brief interventions in primary healthcare to detect and intervene in risky alcohol consumption are cost-effective in reducing drinking problems, but poorly implemented in routine care. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation.Methods: In a cluster randomised factorial trial 120 Primary Healthcare Units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers of 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore there were no significant interactions between these characteristics and allocated groups. Conclusions: The extent to which providers’ managed to change their brief intervention proportions when submitted to different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research more attention is needed for the causal relation between these parameters, as it can inform us whether to focus on these or not in implementation trajectories

The ODHIN assessment tool: a tool to describe the available services for the management of hazardous and harmful alcohol consumption at the country and regional level

Optimizing Delivery of Health care Interventions (ODHIN) is an ongoing European project (EC, FP7) involving research institutions from 9 European countries using the implementation of Early Identification and Brief Intervention (EIBI) programmes for Hazardous and Harmful Alcohol Consumption (HHAC) in Primary Health Care (PHC) as a case study to better understand how to translate the results of clinical research into everyday practice. The Italian National Health Service (ISS) is the project leader of the Work Package 6 assessment tool. The aim of the ODHIN assessment tool is to formalise, operationalise and test the questionnaire developed under the PHEPA project in order to produce an update instrument to assess the extent of implementation of EIBIs for HHAC throughout PHC settings. The ODHIN assessment tool has been conceived as a semi-structured questionnaire for the identification of the state of the art, gaps and areas in the country that need further work and strengthening; to monitor the adequacy of brief intervention programmes for HHAC in order to provide recommendations to improve and optimize delivery of health care interventions. It analyses 24 questions distributed across 7 key sections. Data have been collected from 9 ODHIN collaborating countries (Catalonia, Czech Republic, Italy, Poland, Portugal, Slovenia, Sweden, The Netherlands and United Kingdom) and from other 14 European countries who have agreed to share their national experience with the ODHIN partners (Belgium, Croatia, Cyprus, Estonia, Finland, Fyrom-Yugoslav Republic of Macedonia, Germany, Greece, Iceland, Ireland, Latvia, Malta, Romania, and Switzerland). Preliminary data on the state of the art of the implementation and the extent of EIBI for HHAC throughout PHC settings across 23 European participating countries will be presented. Identified areas where services require development or strengthening across the participating countries as well as examples of good practices between countries will be also discussed

WAG - Kvinnor och alkohol i Göteborg: Intervjuer 2000-2002

The study Women and Alcohol in Gothenburg (WAG) is a longitudinal study that started in 1986. WAG has data from three interview waves, 1989-1992, 1994-1998 and 2000-2002. It comprises data from 2421 interviews, including 1432 baseline interviews and 989 follow-up interviews. In 2013 a new data collection has started in the project. WAG is designed as a two stage study. In the first step, specific female birth cohorts included in the study population for the first time and registered in central and western districts of Gothenburg, received a 13-item alcohol problem screening questionnaire called Women Screening and Alcohol (SWAG). In the second step, women were selected for a structured interview by stratified sampling according to their scores in the SWAG questionnaire. This two-step way enables the group of women with alcohol problems to be greater than in a random sampling. Each wave of data collection consist of baseline interviews birth cohorts included for the first time, as well as follow-up interviews with earlier baseline cohorts. The structured interview questionnaire mainly comprises issues of alcohol habits and mental health, including psychiatric disorders. The questionnaire further covers topics such as women’s working life and family situation, socioeconomic background factors, legal and illegal drug use, past experience from childhood and adolescence and sexual abuse and physical violence during child- and adulthood. Psychiatric diagnoses have been established by clinician interviewers according to the International Classification of Disease (ICD), DSM-III-R and DSM-IV. In the third data collection between 2000 and 2002, the instrument called International Neuropsychiatric Interview (M.I.N.I) was included in the questionnaire and used for diagnostic purpose. Purpose: The primary aim of the project is to follow the development of drinking habits and alcohol problems, to examine the motives women have to drink alcohol, to study the negative consequences of alcohol and to study the relationship between alcohol problems, mental health disorders, anxiety and depression. Data collection between 2000-2002 consist of baseline interviews with birth cohorts included for the first time, as well as follow-up interviews with earlier baseline cohorts.WAG är en förkortning av projektets engelska namn ”Women and alcohol in Gothenburg”, som på svenska översätts till ”Kvinnor och alkohol i Göteborg”. Studien är longitudinell och startade år 1986. Data har samlats in under åren 1989-1992, 1994-1998 och 2000-2002. Från dessa tre insamlingsperioder finns data från 2421 intervjuer, omfattande 1432 baslinjeintervjuer och 989 uppföljningsintervjuer. Under 2013 påbörjades en ny datainsamling i studien, som är pågående. Studien är upplagd som en så kallad tvåstegsstudie. I det första steget skickas ett screeningformulär, SWAG (Screening, women and alcohol in Göteborg), ut till samtliga kvinnor födda ett visst årtal och som är bosatta inom en viss del av Göteborg. Med hjälp av screeninginstrumentet kunde man identifiera personer med alkoholproblem. I andra steget valdes sedan kvinnor ut för en strukturerad intervju via stratifierat urval, baserat på hur de svarat i frågeformuläret. Detta sätt har man använt för att få en större grupp kvinnor med alkoholproblem än vad som hade varit möjligt med ett vanligt slumpmässigt urval. Varje omgång av datainsamling inkluderar dels uppföljningsintervjuer med tidigare baslinjekohorter, och dels baslinjeintervju med födelsekohorter som inkluderas för första gången. De strukturerade intervjuformulären inkluderar framför allt frågor om alkoholvanor och psykisk hälsa, inklusive psykiska sjukdomar. Enkäten omfattar även frågor kring kvinnors arbetsliv och familjesituation, socioekonomiska bakgrundsfaktorer, droganvändning, tidigare erfarenheter från barndomen och tonåren, samt sexuella övergrepp och fysiskt våld under barn- och vuxenlivet. Psykiatriska diagnoser har fastställts enligt internationell klassificering av sjukdomar (ICD), DSM-III-R och DSM-IV. I den tredje datainsamling, mellan 2000 och 2002, användes instrumentet som kallas International Neuropsychiatric Interview (MINI) för diagnostiska ändamål. Syfte: Det huvudsakliga syftet med WAG är att följa utvecklingen av alkoholvanor och alkoholproblem, att undersöka vilka motiv kvinnor har för att dricka alkohol, att studera negativa konsekvenser av alkoholen och att studera sambanden mellan alkoholproblem, psykiska sjukdomar, särskild ångest och depression. Vid den tredje datainsamlingen, 2000-2002, genomfördes dels uppföljande intervjuer med tidigare deltagare, och dels baslinjemätning med ny kohort kvinnor

WAG - Kvinnor och alkohol i Göteborg: Intervjuer 1994-1998

The study Women and Alcohol in Gothenburg (WAG) is a longitudinal study that started in 1986. WAG has data from three interview waves, 1989-1992, 1994-1998 and 2000-2002. It comprises data from 2421 interviews, including 1432 baseline interviews and 989 follow-up interviews. In 2013 a new data collection has started in the project. WAG is designed as a two stage study. In the first step, specific female birth cohorts included in the study population for the first time and registered in central and western districts of Gothenburg, received a 13-item alcohol problem screening questionnaire called Women Screening and Alcohol (SWAG). In the second step, women were selected for a structured interview by stratified sampling according to their scores in the SWAG questionnaire. This two-step way enables the group of women with alcohol problems to be greater than in a random sampling. Each wave of data collection consist of baseline interviews birth cohorts included for the first time, as well as follow-up interviews with earlier baseline cohorts. The structured interview questionnaire mainly comprises issues of alcohol habits and mental health, including psychiatric disorders. The questionnaire further covers topics such as women’s working life and family situation, socioeconomic background factors, legal and illegal drug use, past experience from childhood and adolescence and sexual abuse and physical violence during child- and adulthood. Psychiatric diagnoses have been established by clinician interviewers according to the International Classification of Disease (ICD), DSM-III-R and DSM-IV. In the third data collection between 2000 and 2002, the instrument called International Neuropsychiatric Interview (M.I.N.I) was included in the questionnaire and used for diagnostic purpose. Purpose: The primary aim of the project is to follow the development of drinking habits and alcohol problems, to examine the motives women have to drink alcohol, to study the negative consequences of alcohol and to study the relationship between alcohol problems, mental health disorders, anxiety and depression. Data collection between 1994-1998 consist of baseline interviews with birth cohorts included for the first time, as well as follow-up interviews with earlier baseline cohorts.WAG är en förkortning av projektets engelska namn ”Women and alcohol in Gothenburg”, som på svenska översätts till ”Kvinnor och alkohol i Göteborg”. Studien är longitudinell och startade år 1986. Data har samlats in under åren 1989-1992, 1994-1998 och 2000-2002. Från dessa tre insamlingsperioder finns data från 2421 intervjuer, omfattande 1432 baslinjeintervjuer och 989 uppföljningsintervjuer. Under 2013 påbörjades en ny datainsamling i studien, som är pågående. Studien är upplagd som en så kallad tvåstegsstudie. I det första steget skickas ett screeningformulär, SWAG (Screening, women and alcohol in Göteborg), ut till samtliga kvinnor födda ett visst årtal och som är bosatta inom en viss del av Göteborg. Med hjälp av screeninginstrumentet kunde man identifiera personer med alkoholproblem. I andra steget valdes sedan kvinnor ut för en strukturerad intervju via stratifierat urval, baserat på hur de svarat i frågeformuläret. Detta sätt har man använt för att få en större grupp kvinnor med alkoholproblem än vad som hade varit möjligt med ett vanligt slumpmässigt urval. Varje omgång av datainsamling inkluderar dels uppföljningsintervjuer med tidigare baslinjekohorter, och dels baslinjeintervju med födelsekohorter som inkluderas för första gången. De strukturerade intervjuformulären inkluderar framför allt frågor om alkoholvanor och psykisk hälsa, inklusive psykiska sjukdomar. Enkäten omfattar även frågor kring kvinnors arbetsliv och familjesituation, socioekonomiska bakgrundsfaktorer, droganvändning, tidigare erfarenheter från barndomen och tonåren, samt sexuella övergrepp och fysiskt våld under barn- och vuxenlivet. Psykiatriska diagnoser har fastställts enligt internationell klassificering av sjukdomar (ICD), DSM-III-R och DSM-IV. I den tredje datainsamling, mellan 2000 och 2002, användes instrumentet som kallas International Neuropsychiatric Interview (MINI) för diagnostiska ändamål. Syfte: Det huvudsakliga syftet med WAG är att följa utvecklingen av alkoholvanor och alkoholproblem, att undersöka vilka motiv kvinnor har för att dricka alkohol, att studera negativa konsekvenser av alkoholen och att studera sambanden mellan alkoholproblem, psykiska sjukdomar, särskild ångest och depression. Vid den andra datainsamlingen, 1994-1998, genomfördes dels uppföljande intervjuer med tidigare deltagare, och dels baslinjemätning med ny kohort kvinnor

WAG - Kvinnor och alkohol i Göteborg: Intervjuer 1989-1992

The study Women and Alcohol in Gothenburg (WAG) is a longitudinal study that started in 1986. WAG has data from three interview waves, 1989-1992, 1994-1998 and 2000-2002. It comprises data from 2421 interviews, including 1432 baseline interviews and 989 follow-up interviews. In 2013 a new data collection has started in the project. WAG is designed as a two stage study. In the first step, specific female birth cohorts included in the study population for the first time and registered in central and western districts of Gothenburg, received a 13-item alcohol problem screening questionnaire called Women Screening and Alcohol (SWAG). In the second step, women were selected for a structured interview by stratified sampling according to their scores in the SWAG questionnaire. This two-step way enables the group of women with alcohol problems to be greater than in a random sampling. Each wave of data collection consist of baseline interviews birth cohorts included for the first time, as well as follow-up interviews with earlier baseline cohorts. The structured interview questionnaire mainly comprises issues of alcohol habits and mental health, including psychiatric disorders. The questionnaire further covers topics such as women’s working life and family situation, socioeconomic background factors, legal and illegal drug use, past experience from childhood and adolescence and sexual abuse and physical violence during child- and adulthood. Psychiatric diagnoses have been established by clinician interviewers according to the International Classification of Disease (ICD), DSM-III-R and DSM-IV. In the third data collection between 2000 and 2002, the instrument called International Neuropsychiatric Interview (M.I.N.I) was included in the questionnaire and used for diagnostic purpose. Purpose: The primary aim of the project is to follow the development of drinking habits and alcohol problems, to examine the motives women have to drink alcohol, to study the negative consequences of alcohol and to study the relationship between alcohol problems, mental health disorders, anxiety and depression. At the first data collection, 399 women participated in a personal interview, representing a response rate of 83 %.WAG är en förkortning av projektets engelska namn ”Women and alcohol in Gothenburg”, som på svenska översätts till ”Kvinnor och alkohol i Göteborg”. Studien är longitudinell och startade år 1986. Data har samlats in under åren 1989-1992, 1994-1998 och 2000-2002. Från dessa tre insamlingsperioder finns data från 2421 intervjuer, omfattande 1432 baslinjeintervjuer och 989 uppföljningsintervjuer. Under 2013 påbörjades en ny datainsamling i studien, som är pågående. Studien är upplagd som en så kallad tvåstegsstudie. I det första steget skickas ett screeningformulär, SWAG (Screening, women and alcohol in Göteborg), ut till samtliga kvinnor födda ett visst årtal och som är bosatta inom en viss del av Göteborg. Med hjälp av screeninginstrumentet kunde man identifiera personer med alkoholproblem. I andra steget valdes sedan kvinnor ut för en strukturerad intervju via stratifierat urval, baserat på hur de svarat i frågeformuläret. Detta sätt har man använt för att få en större grupp kvinnor med alkoholproblem än vad som hade varit möjligt med ett vanligt slumpmässigt urval. Varje omgång av datainsamling inkluderar dels uppföljningsintervjuer med tidigare baslinjekohorter, och dels baslinjeintervju med födelsekohorter som inkluderas för första gången. De strukturerade intervjuformulären inkluderar framför allt frågor om alkoholvanor och psykisk hälsa, inklusive psykiska sjukdomar. Enkäten omfattar även frågor kring kvinnors arbetsliv och familjesituation, socioekonomiska bakgrundsfaktorer, droganvändning, tidigare erfarenheter från barndomen och tonåren, samt sexuella övergrepp och fysiskt våld under barn- och vuxenlivet. Psykiatriska diagnoser har fastställts enligt internationell klassificering av sjukdomar (ICD), DSM-III-R och DSM-IV. I den tredje datainsamling, mellan 2000 och 2002, användes instrumentet som kallas International Neuropsychiatric Interview (MINI) för diagnostiska ändamål. Syfte: Det huvudsakliga syftet med WAG är att följa utvecklingen av alkoholvanor och alkoholproblem, att undersöka vilka motiv kvinnor har för att dricka alkohol, att studera negativa konsekvenser av alkoholen och att studera sambanden mellan alkoholproblem, psykiska sjukdomar, särskild ångest och depression. Vid den första datainsamlingen tillfrågades 479 kvinnor om en personlig intervju, varav 399 kvinnor (83 %) deltog