Screening and brief intervention targeting risky drinkers in Danish general practice--a pragmatic controlled trial.

AIMS: Recommendations for routine alcohol screening and brief counselling intervention in primary health care rest on results from intervention efficacy studies. By conducting a pragmatic controlled trial (PCT), we aimed at evaluating the effectiveness of the WHO recommendations for screening and brief intervention (SBI) in general practice. METHODS: A randomized PCT (brief counselling intervention vs no intervention) involving 39 Danish general practitioners (GPs). Systematic screening of 6897 adults led to inclusion of 906 risky drinkers, and research follow-up on 537 of these after 12-14 months. Outcome measures focused on patients' acceptance of screening and intervention and their self-reported alcohol consumption. RESULTS: Patient acceptance of screening and intervention -10.3% (N = 794) of the target population (N = 7, 691) explicitly refused screening. All intervention group subjects (N = 442) were exposed to an instant brief counselling session while only 17.9% of them (79/442) attended a follow-up consultation that was offered by their GP. Consumption Changes At one-year follow-up, average weekly consumption had increased by 0.7 drinks in both comparison groups. As secondary findings, we observed an indiscriminate absolute risk reduction (ARR = 0.08 (95% CI: -0.02; 0.18)) in male binge drinking, but adverse intervention effects for women on the secondary outcomes (binge drinking ARR = -0.30 (95% CI: -0.47; -0.09)). CONCLUSIONS: The results of brief interventions in everyday general practice performed on the basis of systematic questionnaire screening may fall short of theoretical expectations. When applied to non-selected groups in everyday general practice SBI may have little effect and engender diverse outcome. Women may be more susceptible to defensive reactions than men.

Adverse events due to change in organization of problem drug users' treatment?

AIMS: This study set out to identify any undesirable consequences of legislative change in the organization of the treatment of problem drug users (PDUs), which aimed to combine their social and medical care. METHOD: The method used was a register-based three-year follow-up prevalent cohort study. RESULTS: On 1 January 1996, the law was changed to allocate unambiguous and undivided responsibility for the combined social and medical care of PDUs in Denmark. The main objective of the legislative change was to move PDUs from treatment by general practitioners (GPs) and at private clinics to treatment institutions under the control of the counties. The possibility remained that medical treatment could, however, continue to be given by GPs or private clinics, based on specific agreements. The study showed that at the end of the period, 31 December 1998, two-thirds remained in treatment at private clinics or at GP surgeries. During the period only 8% of users were at some time without methadone treatment; 2% remained without methadone treatment throughout the study period. CONCLUSION: The transition from GPs and private clinics to the county treatment centres went smoothly. The number of PDUs in MMT (methadone maintenance treatment) in the city of Copenhagen increased in the period 1995 to 1998. The average quantity of methadone given to the cohort increased during these years from 72 mg per day to 92 mg per day. The legislative change therefore did not result in a higher threshold for treatment or a more restrictive prescription of methadone. No adverse effect on crime, hospital admissions, or death could be attributed to the legislative change in treatment organization.