Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

doi:10.1007/s11606-020-06503-9

Randomized Controlled Trial

. 2021 Sep;36(9):2663-2671.

doi: 10.1007/s11606-020-06503-9. Epub 2021 Jan 19.

Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

Peter Anderson^{1

2}, Jakob Manthey^{3

4}, Eva Jané Llopis^{5

6

7}, Guillermina Natera Rey⁸, Ines V Bustamante⁹, Marina Piazza⁹, Perla Sonia Medina Aguilar⁸, Juliana Mejía-Trujillo¹⁰, Augusto Pérez-Gómez¹⁰, Gill Rowlands¹¹, Hugo Lopez-Pelayo^{12

13

14}, Liesbeth Mercken⁵, Dasa Kokole⁵, Amy O'Donnell¹¹, Adriana Solovei⁵, Eileen Kaner¹¹, Bernd Schulte⁴, Hein de Vries⁵, Christiane Schmidt⁴, Antoni Gual^{12

13

14}, Jürgen Rehm^{3

7

15

16

17}

Affiliations

¹ Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. peter.anderson@maastrichtuniversity.nl.
² Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. peter.anderson@maastrichtuniversity.nl.
³ Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
⁴ Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁶ Univ. Ramon Llull, ESADE, Barcelona, Spain.
⁷ Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada.
⁸ Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico.
⁹ School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁰ Corporación Nuevos Rumbos, Bogotá, Colombia.
¹¹ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
¹² Addictions Unit, Psychiatry Dept., Hospital Clínic, Barcelona, Spain.
¹³ Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain.
¹⁴ Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
¹⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.

PMID: 33469752
PMCID: PMC7815287
DOI: 10.1007/s11606-020-06503-9

Randomized Controlled Trial

Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

Peter Anderson et al. J Gen Intern Med. 2021 Sep.

. 2021 Sep;36(9):2663-2671.

doi: 10.1007/s11606-020-06503-9. Epub 2021 Jan 19.

Authors

Affiliations

¹ Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. peter.anderson@maastrichtuniversity.nl.
² Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. peter.anderson@maastrichtuniversity.nl.
³ Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.
⁴ Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁶ Univ. Ramon Llull, ESADE, Barcelona, Spain.
⁷ Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada.
⁸ Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico.
⁹ School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
¹⁰ Corporación Nuevos Rumbos, Bogotá, Colombia.
¹¹ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
¹² Addictions Unit, Psychiatry Dept., Hospital Clínic, Barcelona, Spain.
¹³ Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain.
¹⁴ Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
¹⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.

PMID: 33469752
PMCID: PMC7815287
DOI: 10.1007/s11606-020-06503-9

Abstract

Purpose: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured.

Methods: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage).

Results: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5).

Conclusions: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions.

Trial registration: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.

Keywords: AUDIT-C; Colombia; Institute for Health Care Improvement; Mexico; Peru; brief advice; heavy drinking; implementation; measurement of alcohol consumption; municipal action; primary health care.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

**Figure 2**
Average cumulative coverage at month 5 for each exposure group, as defined by each hypothesis (points indicate mean and vertical lines indicate mean ± one standard deviation).

See this image and copyright information in PMC

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References

1. Rehm J, Gmel G, Sr, Gmel G, et al. The relationship between different dimensions of alcohol use and the burden of disease - an update. Addiction. 2017;112(6):968–1001. doi: 10.1111/add.13757. - DOI - PMC - PubMed
1. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet. 2018. 10.1016/S0140-6736(18)31310-2.
1. Wood AM, Kaptoge S, Butterworth AS, Willeit P, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23. doi: 10.1016/S0140-6736(18)30134-X. - DOI - PMC - PubMed
1. Shield KD, Manthey J, Rylett M, Probst C, Wettlaufer A, Parry CDH, Rehm J. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health. 2020;5(1):e51–e61. doi: 10.1016/S2468-2667(19)30231-2. - DOI - PubMed
1. World Health Organization. SAFER, Alcohol Control Initiative. 2020. https://www.who.int/substance_abuse/safer/en/.

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[1] Rehm J, Gmel G, Sr, Gmel G, et al. The relationship between different dimensions of alcohol use and the burden of disease - an update. Addiction. 2017;112(6):968–1001. doi: 10.1111/add.13757. - DOI - PMC - PubMed

[2] Rehm J, Gmel G, Sr, Gmel G, et al. The relationship between different dimensions of alcohol use and the burden of disease - an update. Addiction. 2017;112(6):968–1001. doi: 10.1111/add.13757. - DOI - PMC - PubMed

[3] GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet. 2018. 10.1016/S0140-6736(18)31310-2.

[4] GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet. 2018. 10.1016/S0140-6736(18)31310-2.

[5] Wood AM, Kaptoge S, Butterworth AS, Willeit P, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23. doi: 10.1016/S0140-6736(18)30134-X. - DOI - PMC - PubMed

[6] Wood AM, Kaptoge S, Butterworth AS, Willeit P, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23. doi: 10.1016/S0140-6736(18)30134-X. - DOI - PMC - PubMed

[7] Shield KD, Manthey J, Rylett M, Probst C, Wettlaufer A, Parry CDH, Rehm J. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health. 2020;5(1):e51–e61. doi: 10.1016/S2468-2667(19)30231-2. - DOI - PubMed

[8] Shield KD, Manthey J, Rylett M, Probst C, Wettlaufer A, Parry CDH, Rehm J. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health. 2020;5(1):e51–e61. doi: 10.1016/S2468-2667(19)30231-2. - DOI - PubMed

[9] World Health Organization. SAFER, Alcohol Control Initiative. 2020. https://www.who.int/substance_abuse/safer/en/.

[10] World Health Organization. SAFER, Alcohol Control Initiative. 2020. https://www.who.int/substance_abuse/safer/en/.

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Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

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Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial

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Conflict of interest statement

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