Open Access Highly Accessed Open Badges Study protocol

Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial

Myrna N Keurhorst1*, Peter Anderson2, Fredrik Spak3, Preben Bendtsen4, Lidia Segura5, Joan Colom5, Jillian Reynolds6, Colin Drummond7, Paolo Deluca7, Ben van Steenkiste8, Artur Mierzecki9, Karolina Kłoda9, Paul Wallace10, Dorothy Newbury-Birch2, Eileen Kaner2, Toni Gual6 and Miranda GH Laurant1

Author Affiliations

1 Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare (IQ healthcare), P.O. Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands

2 Institute of Health and Society, Medical Faculty, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, United Kingdom

3 Department of Social medicine, University of Gothenburg, P.O. Box 453, 405 30, Gothenburg, Sweden

4 Department of Medicine and Health, Linköping University, 581 83, Linköping, Sweden

5 Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain

6 Hospital Clínic de Barcelona, Addictions Unit, Institut Clínic de Neurosciències, C/Villarroel 170, CP 08036, Barcelona, Spain

7 Addictions Department, National Addiction Centre, Institute of Psychiatry, King’s College London, 4 Windsor Walk, London, SE5 8BB, UK

8 Department of General Practice, Maastricht University, School CAPHRI, P.O Box 616, 6200 MD, Maastricht, The Netherlands

9 Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, ul. Rybacka 1, 70-204, Szczecin, Poland

10 Department of Primary Care and Population Health, University College London, London, UK

For all author emails, please log on.

Implementation Science 2013, 8:11  doi:10.1186/1748-5908-8-11

Published: 24 January 2013



The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.


In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.


Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.

Trial registration Trial identifier: NCT01501552

Alcohol; Screening; Brief interventions; Primary healthcare; Training and support; Financial reimbursement; Internet; Implementation