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

Abstract

BackgroundBrief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. 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.MethodsIn 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.ResultsData from 746 providers from 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 implementation groups.ConclusionsThe extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners’ attitudes, their actual behaviour and care improvement strategies to enhance implementation science.Trial registrationClinicalTrials.gov: NCT01501552 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0468-5) contains supplementary material, which is available to authorized users.

Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital

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Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study

“…Future research should also explore to what extent participants of the Web-based MI course actually implemented MI in their daily routine. Factors influencing the implementation of MI might be therapeutic commitment—the motivation, task-specific self-esteem and work satisfaction toward chronic patients, and role security—the skills, knowledge, and owning a role of working with them, although this theory is debated [13,33]. Future research should focus on the causal relation between practitioners’ attitudes, their actual behavior, and care improvement strategies to enhance implementation science.…”

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Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial

“…Although there have been a number of international studies examining providers’ attitudes in this field [ 12 , 13 , 14 , 15 , 16 ], as far as we are aware, there have been no published studies with repeated attitude measures that have further examined the original model of the Maudsley Alcohol Pilot Project. The European ODHIN (Optimizing delivery of health care interventions) project reported in this paper allows the opportunity to do so.…”