1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence September–October 2012

2. Featured Article Involvement of General Practitioners in Managing Alcohol Problems: A Randomized Controlled Trial of a Tailored Improvement Programme van Beurden I, et al. Addiction. 2012;107(9):1601–1611.

3. www.aodhealth.org3 Study Objective To assess the effect of a tailored multifaceted program to improve general practitioner (GP) screening and counseling for alcohol use disorders.

4. Study Design Cluster randomized controlled trial including 119 GPs from 77 practices in the Netherlands. Only practices in which all GPs agreed to participate could enroll. The primary outcome was the number of eligible patients * (765 of 6318) who received screening and advice according to Dutch College of General Practitioners guidelines. The outcome was assessed based on self- administered pre- and post-program questionnaires. Questions on GP and practice characteristics were included in the baseline questionnaire. *Alcohol Use Disorders Identification Test (AUDIT) score ≥8. The test was distributed to 230 consecutive patients in each participating practice over a 3-month period, with completed tests returned to the research team prior to the start of the improvement program.

5. www.aodhealth.org5 Assessing Validity of an Article about Therapy Are the results valid? What are the results? How do these results apply to my practice?

6. www.aodhealth.org6 Are the Results Valid? Were participants randomized? Was randomization concealed? Were participants analyzed in the groups to which they were randomized? Were participants in groups similar with respect to known variables?

7. www.aodhealth.org7 Are the Results Valid? (cont‘d) Were participants aware of group allocation? Were outcome assessors aware of group allocation? Was follow-up complete?

8. www.aodhealth.org8 Were participants randomized? Yes. –Forty practices (63 GPs) were randomized to the intervention group and 37 (56 GPs) to the control group (receipt of information on problematic alcohol consumption only).

9. www.aodhealth.org9 Was randomization concealed? Yes. –Practices were randomized via computer into equal-sized intervention and control groups.

10. www.aodhealth.org10 Were participants analyzed in the groups to which they were randomized? Yes. –Participants were analyzed in the groups to which they were originally assigned regardless of whether or not they actually participated in the intervention.

11. www.aodhealth.org11 Were participants in the intervention and control groups similar? There were no significant baseline differences between groups except with regard to age. The majority of GPs in both groups were aged 45–50 years; however, GPs in the intervention group were, on average, 4 years younger than controls. Age was included as a covariable during analysis.

12. www.aodhealth.org12 Were participants aware of group allocation? Yes. –Practices were acquainted with the aims of the study when queried about participating, and GPs were informed of their group assignments after completing the baseline questionnaire.

13. www.aodhealth.org13 Were outcome assessors aware of group allocation? Yes.

14. www.aodhealth.org14 Was follow-up complete? No. –In the intervention group, 12 practices were lost to follow-up for medical record reviewing, and 16 GPs did not complete 12- month follow-up questionnaires. –In the control group, 8 practices were lost to follow-up for medical record reviewing, and 15 GPs did not complete 12- month follow-up questionnaires. –Despite multiple reminders, 13 GPs in the intervention group did not attend any educational training sessions or visits by a trained facilitator. –Only half of intervention practices met the minimum commitment that every GP in the practice attended at least 1 training session or facilitator visit. Of these, 55% were solo practices.

15. www.aodhealth.org15 What Are the Results? How large was the treatment effect?

16. www.aodhealth.org16 How large was the treatment effect? The proportion of at-risk patients screened or given advice about alcohol increased from baseline for both groups during the study period but waned at 1-year, with no differences detected between groups. *Answers were frequency per month for screening and frequency per year for counseling.

17. www.aodhealth.org17 How Do These Results Apply to My Practice? Were the study participants similar to my practice? Are the intervention benefits worth the costs?

18. www.aodhealth.org18 Were the study participants similar to my practice? The participants were GP practices in the Netherlands. Since only 3% of 2758 surveyed practices participated in the trial, there is a strong likelihood of bias toward including more motivated practices.

19. www.aodhealth.org19 Are the intervention benefits worth the costs? The intervention was not found to be of benefit, and so costs would not be considered worthwhile.